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Vol. 19. Issue 3.
Pages 136-142 (March 2023)
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Vol. 19. Issue 3.
Pages 136-142 (March 2023)
Original Article
Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis
Estudio respecto a un mayor riesgo de accidente cerebrovascular entre los pacientes con espondilitis anquilosante: revisión sistemática y metaanálisis
Akshaya Srikanth Bhagavathulaa, Barry L. Bentleyb,c, Benjamin Woolfd, Thusharika D. Dissanayakae,f, Jamal Rahmanig,
Corresponding author

Corresponding author.
a Department of Social and Clinical Pharmacy, Faculty of Pharmacy at Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
b Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff, UK
c Collaboration for the Advancement of Sustainable Medical Innovation, University College London, London, UK
d Department of Psychological Sciences, University of Bristol, Bristol BS8 1TH, UK
e Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka
f Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
g Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke.


A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity.


A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33–1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23–1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=−0.0010, P=0.951).


This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.

Ankylosing spondylitis
Cerebrovascular accident
Hazard ratio
Systematic review meta-analysis

La espondilitis anquilosante es una enfermedad inflamatoria crónica que se asocia con eventos cardiovasculares adversos. Este estudio tuvo como objetivo determinar la relación entre la espondilitis anquilosante y el riesgo de accidente cerebrovascular.


Se realizó una búsqueda sistemática de la literatura en PubMed/Medline, Scopus y Web of Science a partir de diciembre de 2021 para identificar los artículos relevantes que investigan el riesgo de accidente cerebrovascular en pacientes con espondilitis anquilosante. Se usó un modelo de efectos aleatorios (Dersimonian y Laird) para estimar una relación de peligro agrupada (HR) e intervalos de confianza (IC) del 95%. Meta-regresión basada en la duración del seguimiento y análisis de subgrupos basados en el tipo de accidente cerebrovascular, la ubicación de estudio y año de publicación para investigar la fuente de heterogeneidad.


Un total de 11 estudios que comprenden 1,7 millones de participantes, se incluyeron en este estudio. El análisis agrupado mostró un riesgo de accidente cerebrovascular significativamente aumentado (56%) entre los pacientes con espondilitis anquilosante (HR: 1,56; IC 95%: 1,33-1,79). El análisis de los subgrupos reveló un mayor riesgo de accidente cerebrovascular isquémico entre los pacientes con espondilitis anquilosante (HR: 1,46; IC 95%: 1,23-1,68). Sin embargo, el análisis de meta-regresión no mostró ninguna asociación entre la duración de la espondilitis anquilosante y la incidencia de accidentes cerebrovasculares (coef=−0,0010; P=0,951).


Este estudio revela que la espondilitis anquilosante se asocia a un mayor riesgo de sufrir un accidente cerebrovascular. La gestión de los factores de riesgo cerebrovasculares y el control de la inflamación sistémica deben considerarse en pacientes con espondilitis anquilosante.

Palabras clave:
Espondilitis anquilosante
Accidente cerebrovascular
Relación de peligro
Revisión sistemática de metaanálisis


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