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Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis

journal contribution
posted on 14.06.2022, 13:08 authored by Akshaya Srikanth Bhagavathula, Barry L Bentley, Benjamin Woolf, Thusharika D. Dissanayaka, Jamal Rahmani


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.


Published in

Reumatología Clínica




AM (Accepted Manuscript)


Bhagavathula, A.S., Bentley, B.L., Woolf, B., Dissanayaka, T.D. and Rahmani, J. (2022) 'Increased risk of stroke among patients with ankylosing spondylitis: A systematic review and meta-analysis', Reumatología Clínica. DOI: 10.1016/j.reuma.2022.04.001

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Cardiff Met Affiliation

  • Cardiff School of Technologies

Cardiff Met Authors

Barry Bentley

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