Cardiovascular risk in axial spondyloarthritis: the interplay of inflammation, traditional risk factors, and management strategies.

Cardiovascular (CV) morbidity and mortality pose major challenges in patients with axial spondyloarthritis (AxSpA), a chronic inflammatory disorder that includes both radiographic and non-radiographic forms. Patients with AxSpA have heightened CV morbidity and mortality, mainly attributable to systemic inflammation and typical CV risk factors like hypertension, hyperlipidemia, diabetes, and obesity. Subclinical atherosclerosis frequently manifests independently of conventional risk factors and is associated with indicators of disease activity and inflammatory load. Established CV risk assessment tools generally underestimate the actual risk in AxSpA, since inflammation leads to endothelial dysfunction and promotes atherosclerosis, highlighting the necessity for customized screening strategies. Pharmacological options, including tumor necrosis factor inhibitors, have demonstrated efficacy in reducing CV risk by mitigating inflammation and improving vascular stability. The role of nonsteroidal anti-inflammatory drugs is intricate, with specific data indicating possible preventive benefits against CV events associated with favorable inflammation management. Lifestyle modifications, including smoking cessation, dietary enhancements-especially adherence to the Mediterranean diet-and increased physical activity are essential adjuncts for mitigating CV risk in this demographic. Innovative digital health technologies and integrated CV-musculoskeletal rehabilitation programs offer promising opportunities for personalized management. Despite progress, further investigation is essential to develop AxSpA-specific CV risk models, investigate sex-specific disparities, and implement multidisciplinary strategies to enhance CV outcomes. Timely identification and thorough treatments are crucial for strengthening long-term outcomes in AxSpA patients.

© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.