When you think of ankylosing spondylitis (AS), back pain is probably the first thing that comes to mind. But heart disease — an umbrella term for several types of heart disease — should also be on your radar.
Research shows that ankylosing spondylitis increases the risk of heart disease and stroke by up to 60%. The probability is higher among adults 20-39. Fortunately, there are things you can do to help reduce your odds. Here’s how to take care of your heart when you have AS.
Can ankylosing spondylitis cause heart disease?
It depends. Inflammation that damages your joints can do the same to your heart, especially your aorta. This is the large artery that carries blood from the heart to the rest of the body.
“Over time, this can lead to high blood pressure, as well as to aortic valve disease, which occurs when the valve between the left ventricle — the main pumping chamber of your heart — and the aorta doesn’t work properly,” says Eliot Antman, MD. Cardiologist at Brigham and Women’s Hospital in Boston.
The valve begins to leak, which can lead to shortness of breath, chest pain, and dizziness.
“If you already have high blood pressure, the valve will leak even more,” Antmann says.
People with ankylosing spondylitis are also at risk of developing other heart conditions. These include:
Arrhythmia. This happens when your heart beats too fast or too slow. Problems with your heart’s electrical conduction system or other heart problems can also trigger it.
Cardiomyopathy. This causes the heart muscle to enlarge and weaken. This makes it difficult to pump blood to the rest of the body. Without treatment, it can lead to heart failure.
Ischemic heart disease. Also called atherosclerosis, this type of heart disease cuts off the blood supply to the heart muscle.
Many people with ankylosing spondylitis are also put on high doses of non-steroidal anti-inflammatory drugs (NSAIDs) to treat symptoms.
“It causes your body to hold on to salt and water, which in turn causes your blood pressure to rise,” Antmann says.
Research suggests that people who take NSAIDs for a long time are more likely to have a heart attack or stroke than those who do not take them.
“We don’t rule out these drugs, because they can help a lot of patients, but we definitely try to keep people on the lowest possible dose for the shortest amount of time,” Antmann says.
Warning signs to watch
If you have ankylosing spondylitis, you should be alert for signs of heart disease. These include:
- Shortness of breath
- Heart palpitations (you may feel like your heart is beating too fast or notice that it’s skipping a beat)
- Swelling in the legs, ankles and feet
- Unable to exercise as much
Talk to your doctor if you notice any of these symptoms.
How to help your heart
It’s important to make sure your heart is in good shape when you have ankylosing spondylitis. These tips can help you:
Exercise a lot. It can be hard to stay active. But if you don’t, you’ll likely gain weight, which in turn will raise your blood pressure, Antmann says. Make a goal of 30 minutes of light, moderate intensity exercise, such as walking or swimming, 5 days a week. Try adding two days of strength training. Yoga is also a good option. One small study found that people with ankylosing spondylitis who practiced yoga every day for two weeks reported less pain and lower blood pressure.
Know your numbers. This includes blood pressure, cholesterol and triglyceride levels, blood glucose levels, and body weight.
“The more these things are under control, the better for your heart health,” Antmann says.
If you’re prescribed medications to control high blood pressure, high cholesterol, or type 2 diabetes, make sure you take them the way you’re supposed to. If you have heart disease, ask your doctor if you should take a certain class of ankylosing spondylitis medications known as tumor necrosis factor inhibitors. A 2018 study found that patients with arthritis conditions such as AS who took these medications had fewer heart attacks such as heart attack or stroke.
Eat a heart-healthy diet. The two most well-studied eating patterns, Antmann says, are the Mediterranean diet and the DASH diet. Both are rich in fruits, vegetables, whole grains, and healthy fats found in foods like fatty fish and olive oil. You also need to limit your salt intake. Aim for less than 1,500 milligrams per day, as this can worsen your blood pressure.
Do not smoke. It not only increases the risk of heart disease, but also causes more joint damage in patients with ankylosing spondylitis.
When should I visit a cardiologist?
Most of the time, your primary care doctor or rheumatologist can monitor your heart, Antmann says. But you should ask for a referral to a cardiologist if:
- You have been diagnosed with high blood pressure, cholesterol or type 2 diabetes.
- Your doctor hears an abnormal sound (murmur) when listening to your heart with a stethoscope.
- You have symptoms that could be signs of a heart condition, such as shortness of breath or chest pain.
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