CV Disease, Drug Abuse Big Contributors to Mortality in Ankylosing Spondylitis

Heidi Splete

September 22, 2023


Drug use disorder increased the likelihood of in-hospital mortality more than 10-fold in patients with ankylosing spondylitis (AS), compared with patients who did not die while hospitalized.


  • Researchers reviewed data from 2125 adults with AS who were hospitalized between 2015 and 2017, using the Cerner Health Facts Database.

  • The final analysis included 41 patients with AS who died while hospitalized and 260 random control patients with AS who did not die.

  • The mean age of the deceased patients with AS was 70 years, 85% were male, and 81% were White; 71% had hypertension, 32% had kidney disease, and 22% had congestive heart failure.


  • Among the patients with AS, cardiovascular disease was the most frequent cause of death, followed by infection, respiratory failure, and fracture/trauma in 15, 14, 8, and 7 patients, respectively. (Some patients had more than one cause of death recorded in the discharge summary.)

  • The most common cardiac causes of death were myocardial infarction and cardiac arrest, while the top causes of acute respiratory failure were pneumonia and pulmonary embolism.

  • Drug abuse, including opioid dependence, was significantly associated with death among hospitalized patients with AS (adjusted odds ratio, 10.9; P = .001).

  • Congestive heart failure and kidney disease were the comorbidities most strongly associated with mortality; the odds of death in the presence of CHF rose 2.76-fold, and it increased 2.46-fold in the presence of kidney disease.


Underlying comorbidities, especially cardiac and renal, are associated with mortality in AS, and patients should be screened early on for these comorbidities to help reduce the odds of death.


First author Mohamad Bittar, MD, of the University of Tennessee Health Science Center, Memphis, and colleagues reported their findings September 21 in Clinical Rheumatology.


The study lacked AS-specific data such as disease activity scores, which were not included in the database; other missing data included variables linked to disease activity and mortality, including smoking, BMI levels, and C-reactive protein levels.


The study received no outside funding. Several co-authors disclosed financial relationships with companies including UCB, Amgen, Pfizer, AbbVie, Novartis, and Eli Lilly.

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