Ankylosing Spondylitis: Manage Heart Disease Risk
Rheumatic ConditionsAnkylosing Spondylitis
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Ankylosing Spondylitis and Your Heart Disease Risk

Ankylosing Spondylitis and Your Heart Disease Risk
Canva (2); Everyday Health
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Updated on February 12, 2025
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Ankylosing spondylitis (AS) does more than cause the telltale symptoms of lower back pain and stiffness — it can cause a range of symptoms and complications throughout your body, including an increased risk for heart disease.

Studies show that people with AS are at a higher risk of the following heart conditions:

  • Aortitis, or inflammation of the aorta, the largest artery in the human body
  • Heart arrhythmias, which occur when the heart beats irregularly, too fast, or too slow
  • Aortic valve insufficiency, which occurs when one of the heart’s valves does not close properly
  • Cardiomyopathy, which happens when the heart’s muscle becomes weak and enlarged
  • Ischemic heart disease, which occurs when your heart muscles do not receive enough blood supply
  • Atherosclerosis, the hardening of blood vessels as a result of plaque build-up
  • Heart failure, which happens when the heart doesn’t pump enough blood throughout the body
But you’re not powerless in the face of heart disease if you have ankylosing spondylitis. Making heart-healthy choices and taking control of your cardiovascular risk factors can help protect you.

Keep reading to understand how AS can affect your heart disease risk, what you can do to lower it, and how to keep your heart healthy.

How AS Impacts Heart Disease Risk

Ankylosing spondylitis is characterized by inflammation in certain joints, mainly the sacroiliac joints (where the spine attaches to the pelvis), the spine, and the hips. This inflammation causes symptoms such as low back pain and stiffness.

The same inflammation that causes this pain may also be responsible for the elevated heart risks seen in people with AS. Specifically, the inflammation can accelerate atherosclerosis, leading to other forms of heart disease and cardiovascular events.

Ankylosing spondylitis isn’t the only form of arthritis linked to heart disease, says David Pisetsky, MD, a rheumatologist and professor of medicine at the Duke University School of Medicine in Durham, North Carolina.

“Most rheumatic diseases are associated with increased risk for cardiovascular disease,” Dr. Pisetsky says. "AS, rheumatoid arthritis, psoriasis, and lupus all have inflammatory components, and when the immune system gets inflamed, it may play out in the cardiovascular system as much as the joints.”

Some heart conditions may also be determined genetically. According to a large genome-wide association study of European populations, there’s a possible genetic link between AS and:

  • Heart failure
  • High blood pressure
  • Ischemic stroke
This could mean that AS directly causes heart disease through a genetic link, although the exact mechanisms behind this link remain unknown.

The same study found no genetic link between AS and:

  • Coronary heart disease
  • Cardiomyopathy
  • Heart valve disease
In other studies, heart arrhythmias and atherosclerosis were not found to have a genetic component.

People with ankylosing spondylitis are also more likely to have high cholesterol and high blood sugar (hyperglycemia) and to be overweight or obese — all factors that further increase heart disease risk, says Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City.

Costochondritis Pain vs. Heart Attack

Many people with AS also have a condition called costochondritis, which is a benign (harmless) inflammation of the cartilage that connects your ribs to your breastbone. Costochondritis usually goes away on its own, but it can cause severe chest pain that’s often confused with the pain of a heart attack.

Seek medical attention if you’re experiencing chest pain, so your doctor can help rule out more serious conditions. If the cause of your pain is costochondritis, they can recommend breathing exercises, stretches, or medication to help you manage the pain.

How AS Medications Can Increase Heart Disease Risk

While inflammation is a likely common factor in ankylosing spondylitis and heart disease, other factors may also play a role, Pisetsky says.

For example, some of the medications used to treat ankylosing spondylitis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can increase the risk for heart disease. Long-term use of NSAIDs raise the risk of heart attack, cardiovascular mortality, and stroke.

COX-2 inhibitors, which are a kind of NSAID, have been shown to lead to ischemic heart disease.

Prednisone, a type of glucocorticoid that’s sometimes used to relieve inflammation in AS, can lead to high blood pressure, high blood sugar, and weight gain if used for long periods of time.

Finally, some AS disease-modifying antirheumatic drugs (DMARDs), such as JAK inhibitors, can also raise cholesterol and the risk of heart disease.

It’s important to note, however, that some DMARDs, such as TNF-alpha inhibitors, can have the opposite effect and protect your heart. Some TNF-alpha inhibitors, such as etanercept (Enbrel) have been shown to reduce cholesterol and blood fats, protecting against atherosclerosis.

Reduce Your Risk: Take Care of Your Heart

While research on ways to combat heart disease in people with ankylosing spondylitis is ongoing, the best thing you can do for your heart in the meantime is to stay on top of your heart disease risk factors.

Tests and Screenings

It’s important to schedule regular appointments with a rheumatologist and a cardiologist, says Eric L. Matteson, MD, a rheumatologist and professor emeritus of medicine at the Mayo Clinic in Rochester, Minnesota.

People with AS should get annual physicals and heart checkups, such as echocardiograms, which check for heart valve disease and heart tissue damage.

 Dr. Matteson also recommends "going for routine stress tests — tests that show how the heart works during physical activity — so your doctor can listen for any abnormal heart sounds that could indicate problems with the aorta."

Lifestyle Habits

“Get control of blood fats and cholesterol, minimize your use of NSAIDs where possible, and exercise if you can,” Matteson advises. “Don’t smoke. If you do, quit.” Smoking not only increases the risk for heart disease, but it also is linked to disease progression and a poor response to treatment in ankylosing spondylitis.

Getting regular exercise is known to reduce a person’s heart disease risk. If AS pain keeps you from exercising, talk to your doctor about what types of exercise may cause the least amount of pain.

Know Your Risk Factors

Not everyone with ankylosing spondylitis has the same risk factors for heart disease, emphasizes Suzanne Steinbaum, DO, a cardiologist in private practice in New York City. “It is extremely important that you know your risk factors and your family history,” she says. “And be really aggressive about managing all of the known risk factors.”

The Takeaway

  • Ankylosing spondylitis can raise your risk of various cardiovascular problems, such as inflammation of the aorta, arrhythmias, atherosclerosis, heart valve disease, and ischemic heart disease.
  • AS may cause heart disease through inflammation, genetic links, or as a result of AS medication.
  • Adopting a heart-healthy lifestyle can go a long way toward lowering your cardiovascular risk.
  • Make sure to keep regular appointments and annual heart checkups, quit smoking, exercise, and keep your cholesterol and other blood lipids in range as much as possible.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. The Heart in Spondyloarthritis. Spondylitis Association of America.
  2. Xiao L et al. Effects of ankylosing spondylitis on cardiovascular disease: a Mendelian randomization study. Frontiers in Genetics. June 26, 2024.
  3. Chen H et al. Ankylosing spondylitis and cardiovascular disease: A two-sample Mendelian randomization analysis. Medicine (Baltimore). December 13, 2024.
  4. Possible Complications of Spondylitis. Spondylitis Association of America.
  5. Heart Health and Axial Spondylitis: Outlook, Risks, and Helpful Tips. Spondylitis Association of America.
  6. Sunmboye K et al. Predicting cardiovascular events in patients on JAK inhibitor therapy: utilizing age and deprivation deciles: a comprehensive study across three hospital sites in the United Kingdom. Annals of the Rheumatic Diseases. June 10, 2024.
  7. Hintenberger R et al. Cardiovascular risk in axial spondyloarthritis—a systematic review. Clinical Rheumatology. July 7, 2023.
  8. Smoking Worsens Ankylosing Spondylosis Damage. The Arthritis Foundation.
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Samir Dalvi, MD

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Samir Dalvi, MD, is a board-certified rheumatologist. He has over 14 years of experience in caring for patients with rheumatologic diseases, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and gout.

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