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Ankylosing spondylitis (AS) is primarily characterized by back pain and reduced mobility in the lower spine. A form of axial spondyloarthritis, AS is further associated with several nonjoint complications, including heart disease.

An estimated 2 percent to 10 percent of people with AS experience some form of heart disease. Long-term AS and joint symptoms in the extremities may be risk factors for heart disease. Regular heart checkups and self-monitoring, as well as adopting a healthy lifestyle, can help prevent a more serious heart condition or slow its progression.

What Causes Heart Disease in Ankylosing Spondylitis?

The exact mechanisms of how AS leads to heart disease are still under investigation. In general, it’s thought that the chronic inflammation associated with AS can reduce blood flow to the heart and damage the aortic valve. The long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), used to reduce symptoms of AS, also may increase the risk of heart disease. These NSAIDs, which include ibuprofen (Advil) and naproxen (Aleve), are commonly prescribed to treat inflammation and pain.

Types of Heart Disease Associated Ankylosing Spondylitis

Ankylosing spondylitis is associated with several types of heart disease, some of which may cause similar symptoms, such as fatigue, dizziness, or chest pain.

Aortitis

The aorta is a large artery responsible for supplying oxygenated blood from the heart to the rest of the body. Aortitis is inflammation of the aorta. The condition most often leads to insufficient blood transport (called aortic insufficiency) and high blood pressure. Over time, the inflammation can result in a leaky valve, which may require surgery.

Valvular Disease

There are two types of aortic valve disease: regurgitation and stenosis. Aortic regurgitation occurs when the aortic valve does not seal properly, allowing some of the blood being pumped to flow backward into the heart. Aortic stenosis describes a narrowing of the aortic valve opening, which restricts blood flow to the aorta.

Both regurgitation and stenosis impair blood flow to the rest of the body and can result in chest pain, dizziness, and difficulty breathing.

Conduction Disorders (Arrhythmias)

Conduction describes how the electrical impulses that generate heartbeats are transmitted. Conduction disorders may result in a heartbeat that is too fast, slow, or irregular, called arrhythmias. Symptoms of conduction disorders can include:

• Chest pain
• Fatigue
• Fluttery feeling in the chest
• Dizziness
• Cardiac arrest, in severe cases

Cardiomyopathy

Cardiomyopathy refers to changes to the heart muscle (such as scarring or enlargement) that diminish the organ’s blood-pumping ability. Symptoms of cardiomyopathy include:

• Breathlessness
• Fluid buildup in the legs or abdomen
• Chest pain
• Fatigue
• A cough when lying down

If left untreated, cardiomyopathy may lead to heart failure, so early detection is important.

Ischemic Heart Disease

Also known as coronary heart disease or coronary artery disease, ischemic heart disease refers to a set of heart conditions in which the heart muscle is not adequately supplied with oxygenated blood. This is caused by a narrowing of the coronary artery. A person with at least one close family member with ischemic heart disease has an estimated 40 percent to 60 percent chance of developing it. Symptoms include chest pain or pressure, as well as trouble breathing.

Managing the Risk of Cardiovascular Disease

You can take steps to protect your health and reduce your overall risk of developing heart disease, even with ankylosing spondylitis. Remember to eat well, exercise, sleep well, and stay on top of your doctor visits.

Eating a Healthy Diet

Eating a varied diet that is low in trans and saturated fats and full of vegetables, fruits, whole grains, and fish can help lower your low-density lipoprotein (LDL) — or “bad” — cholesterol levels. Keeping your LDL cholesterol levels in check can help prevent plaque buildup in your arteries that disturbs blood flow.

Exercising Regularly

Adopting a regular aerobic exercise routine is great for your heart, because it helps increase levels of high-density lipoprotein (HDL) — or “good” — cholesterol. HDL cholesterol is associated with a lower risk of heart disease. Try to get 30 minutes of moderate to vigorous exercise five day per week, which can also help in the management of AS pain.

Sleeping

A good night’s rest can help control blood pressure and reduce your risk of having a stroke or heart attack, so getting at least six to eight hours is an important part of heart health.

Self-Monitoring and Regular Checkups

You can help catch early signs of heart disease by staying attuned to your body and noticing changes. “I have to have a 24-hour heart monitor fitted to see what is going on with my heart,” wrote one MySpondylitisTeam member. “I have had AS for around 20 years now, and these symptoms started about two months ago.”

It’s important to make note and tell your doctor as soon as possible if you begin to experience any of these symptoms:

• Shortness of breath
• Dizziness
• Lightheadedness
• Chest pain
• Heart fluttering
• Leg swelling
• Fatigue

You may also want to ask your doctor if an echocardiogram is appropriate during your annual physical exam. An echocardiogram uses a combination of electrodes and ultrasound technology to provide information about the heart’s structure, rhythm, and blood flow to detect abnormalities or damage.

Treating Heart Disease and Ankylosing Spondylitis

A combination of lifestyle changes, medications (such as ACE inhibitors or beta-blockers), and medical procedures may be part of your treatment plan. Even small lifestyle changes, like carving out time every day for some aerobic exercise, can help alleviate AS symptoms, increase blood flow, and strengthen your heart.

In some cases, a surgical procedure — such as the implantation of a pacemaker or a stent — might be necessary. “I had the fluttering heart and increase in blood pressure last year,” wrote one MySpondylitisTeam member. “They did a heart ablation and fixed it.”

Talk to your doctor about the best plan for you, if you need to treat a heart condition with your spondylitis.

Finding Support

MySpondylitisTeam provides you with access to a community of more than 85,000 people living with spondylitis. They understand the challenges you may be facing and have found creative ways to cope.

Are you living with AS and a heart condition? What advice would you give to someone with a recent diagnosis? Share your thoughts below in the comments or join and post on MySpondylitisTeam.