Lifetime Risks of Valvular Heart Disease and Pacemaker Use in Patients With Ankylosing Spondylitis

BACKGROUND: The likelihoods of valvular heart disease (VHD) and conduction abnormalities in patients with ankylosing spondylitis (ASp) are poorly defined. Knowing their lifetime risks of VHD and pacemaker use would help inform whether cardiac screening should be done. METHODS AND RESULTS: Patients with ASp and a comparison group without ASp were identified among US Medicare beneficiaries in 1999 to 2013. Frequencies of VHD and pacemaker use were compared in 4 age groups: 65 to 69 years, 70 to 74 years, 75 to 79 years, and 80 years or older, as were rates of valve surgeries, a measure of VHD severity, and new pacemaker insertions. Outcomes were compared between 42 327 patients with ASp and 19 211 703 patients without ASp. The prevalence of aortic valve disease in patients with ASp increased with age (2.6%, 6.7%, 10.9%, and 17.1%), as did the prevalence of mitral valve disease. Risks of VHD were slightly but significantly higher in patients with ASp (adjusted odds ratios 1.06–1.51). Rates of aortic valve replacement/repair were also higher in patients with ASp than in the comparison group (125 versus 93; 183 versus 149; 261 versus 208; 279 versus 191 per 100 000 patient‐years in the 4 age groups). Rates of mitral valve surgery did not differ between groups. Among patients with ASp, pacemaker use ranged from 1.0% to 7.6% across age groups, and was slightly higher than in controls (odds ratio range 1.11–1.32). CONCLUSIONS: Lifetime risks of VHD and pacemaker use in ASp increase markedly with age, but are only slightly higher than in elderly people without ASp.