Secondary prevention
Patients with inflammatory conditions such as AS are likely to be at higher risk for cardiovascular disease (CVD).[231][247] The European League Against Rheumatism has published recommendations for cardiovascular risk management in inflammatory arthritis, including AS:[124]
Addressing traditional risk factors (including smoking, hypertension, cholesterol, diabetes), as well as optimal treatment of the underlying inflammatory disease
Undertaking CVD risk assessment at least once every 5 years and following major changes in anti-rheumatic therapy. Patients at high risk of CVD may be re-screened on a more frequent basis as judged appropriate by the treating clinician
Using the SCORE CVD risk prediction model if no national guideline for CVD risk assessment is available.[125] Total cholesterol and high-density lipoprotein cholesterol should form part of CVD risk assessment and should ideally be measured when disease activity is stable or in remission
Providing advice on diet and smoking cessation
Prescribing non-steroidal anti-inflammatory drugs (NSAIDs) in accordance with treatment-specific recommendations.
Patients should receive specific education about the importance of smoking cessation to:[126]
Modify their cardiovascular risk
Reduce their risk of radiographical progression
Where appropriate, optimise individual response to anti-tumour necrosis factor-alpha.
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