Does Chronic Inflammation from Ankylosing Spondylitis Raise LDL and Heart Disease Risk?

Q: Does Chronic Inflammation from Ankylosing Spondylitis Raise LDL and Heart Disease Risk?

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>I am 55 years old and a patient with ankylosing spondylitis. <br>About 4 to 5 years ago, I was effectively managing my condition with Salazopyrin and Celebrex, which normalized my pain and inflammatory marke

Does chronic inflammation from ankylosing spondylitis lead to elevated LDL (low-density lipoprotein) levels, increasing the risk of cardiovascular disease?

1.
I am 55 years old and a patient with ankylosing spondylitis.
About 4 to 5 years ago, I was effectively managing my condition with Salazopyrin and Celebrex, which helped normalize my pain and inflammation markers, so I discontinued the medication.
However, shortly after stopping, I experienced some discomfort, leading me to intermittently take Celebrex (only when the pain became unbearable).
Three years ago, my health check revealed elevated LDL levels (I am 164 cm tall and weigh 68 kg, with a diet low in takeout and sugar, and high in vegetables).
This year, my LDL levels increased further to 216 mg/dL.
I found some information online suggesting that chronic inflammation can lead to elevated LDL levels.
Could my tendency to endure pain (possibly indicating ongoing inflammation) and not taking Celebrex regularly be contributing to my increased LDL levels?
2.
I am concerned that long-term use of Celebrex may put a strain on my kidneys.
However, would it be appropriate to take 200 mg of Celebrex every 2 to 3 days to manage my inflammation?

VC.L, 50~59 year old female. Ask Date: 2023/12/20

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
I am 55 years old and a patient with ankylosing spondylitis.
About 4 to 5 years ago, I was effectively managing my condition with Salazopyrin and Celebrex, which normalized my pain and inflammatory markers, so I stopped taking the medication.
However, shortly after discontinuing, I experienced some discomfort, so I have been taking Celebrex intermittently (only when the pain becomes unbearable).
Three years ago, my health check revealed elevated LDL levels (height 164 cm, weight 68 kg, minimal outside food, low sugar intake, and a diet rich in vegetables).
This year, my LDL increased further to 216 mg/dL.
I found some information online stating that chronic inflammation can lead to elevated LDL levels.
Could my tendency to endure pain (possibly indicating ongoing inflammation) and not taking Celebrex to manage inflammation be the reason for my elevated LDL? --> Inflammation can exacerbate the damage LDL does to blood vessels, but it is not inflammation that causes LDL levels to rise.
The increase in LDL is primarily related to individual metabolic capacity for cholesterol, with a smaller contribution from diet.
Increasing physical activity can lower cholesterol levels, but if LDL remains high despite efforts in exercise, dietary adjustments, and maintaining a regular routine, medication may be necessary.
Additionally, as we age, our body's ability to metabolize cholesterol declines, making exercise increasingly important.
2.
I am concerned that continuous use of Celebrex may burden my kidneys.
Is it appropriate to take 200 mg of Celebrex every 2 to 3 days to manage inflammation? --> If the goal is to control inflammation, Celebrex is often not sufficient on its own, and Salazopyrin is usually required.
The purpose of Celebrex is to alleviate pain, improve quality of life, and enhance the willingness to exercise, thereby creating a positive cycle of pain management and reducing the need for painkillers.
We do not rely solely on Celebrex to manage inflammation.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/12/20

More Info

Chronic inflammation, particularly from conditions like Ankylosing Spondylitis (AS), can indeed have significant implications for cardiovascular health, including the elevation of LDL cholesterol levels and an increased risk of heart disease. In your case, it seems that despite managing your AS symptoms with medications like Salazopyrin (Salsalate) and Celebrex (Celecoxib), you have experienced fluctuations in your LDL levels, which have risen to 216 mg/dL.

Research has shown that chronic inflammatory states can lead to dyslipidemia, characterized by elevated LDL cholesterol and triglycerides. Inflammation can alter lipid metabolism, leading to an increase in the production of LDL particles and a decrease in their clearance from the bloodstream. This is particularly relevant in autoimmune conditions like AS, where systemic inflammation is a hallmark of the disease. The inflammatory cytokines released during this process can interfere with normal lipid metabolism, contributing to the observed elevations in LDL cholesterol.

Your concern about whether the intermittent use of Celebrex to manage pain and inflammation could be contributing to your elevated LDL levels is valid. While non-steroidal anti-inflammatory drugs (NSAIDs) like Celebrex are effective for managing pain and inflammation, they do not directly lower LDL levels. However, if your underlying inflammation is not adequately controlled, it could lead to sustained elevations in LDL cholesterol. Therefore, it is essential to find a balance between managing your pain and inflammation effectively while also addressing your lipid levels.

Regarding your question about the long-term use of Celebrex, it is crucial to consider both the benefits and potential risks. Long-term use of NSAIDs can lead to gastrointestinal issues, cardiovascular risks, and renal impairment, especially in individuals with pre-existing conditions. However, if your AS is causing significant discomfort and impacting your quality of life, it may be necessary to continue using Celebrex, but under the guidance of your healthcare provider. A dose of 200 mg every 2-3 days may be appropriate for managing your symptoms, but this should be regularly reviewed by your doctor to ensure it is safe and effective for you.

In addition to medication, lifestyle modifications can play a critical role in managing both inflammation and cholesterol levels. Regular physical activity, a balanced diet rich in omega-3 fatty acids, fiber, and antioxidants, and maintaining a healthy weight can help reduce inflammation and improve lipid profiles. It may also be beneficial to monitor your lipid levels regularly and discuss with your healthcare provider the possibility of introducing lipid-lowering medications if lifestyle changes alone are insufficient.

In summary, chronic inflammation from Ankylosing Spondylitis can indeed raise LDL levels and increase heart disease risk. It is essential to manage your inflammation effectively while also monitoring your lipid levels. Regular follow-ups with your healthcare provider will help tailor your treatment plan to address both your AS and cardiovascular health.

Similar Q&A

Does Ankylosing Spondylitis Increase Risk of Low White or Red Blood Cells?

Hello Dr. Tseng, I am a patient with ankylosing spondylitis, 20 years old, and I have been diagnosed with ankylosing spondylitis for 3.5 years. I am currently undergoing stable treatment. I would like to ask the doctor, excluding the effects of medications used in treatment, does...

Dr. Zeng Guosen reply Internal Medicine
Ankylosing spondylitis is not a common disease, and leukopenia or anemia may occur in some patients. Chronic inflammation over time can potentially lead to anemia. It is recommended to follow up with your physician for differential diagnosis. Thank you.

Can Ankylosing Spondylitis Cause Chest Pain? Understanding Your Symptoms

I have ankylosing spondylitis and have been experiencing severe chest pain for several years. Recently, the condition has worsened, resulting in persistent overall pain that is difficult to pinpoint. Deep breathing or movements of the chest tend to exacerbate the pain. Pain relie...

Dr. Zeng Guosen reply Internal Medicine
Ankylosing spondylitis can affect the sternum and surrounding ribs, as well as other cartilage or connective tissues, leading to inflammation and pain. However, other causes of chest pain should also be ruled out. It is recommended to seek medical attention for differential diagn...

Understanding Inflammation Index and Its Impact on Adhesion in Ankylosing Spondylitis

Hello, Doctor. I have ankylosing spondylitis. Before treatment, I experienced pain in my buttocks and lower back. For the past year, I have been taking two tablets of Celebrex daily, and my CRP levels have been maintained within the normal range. The pain in my buttocks has almos...

Dr. Zeng Guosen reply Internal Medicine
The likelihood of spinal adhesions is related to various factors, including inflammation levels, smoking, previous adhesions, obesity, and more. Of course, if there is no pain and inflammation levels are normal, the chances of developing adhesions in the lower back are reduced. E...

Understanding the Link Between Ankylosing Spondylitis and Vaccination

Hello Doctor, I am a 51-year-old male patient with ankylosing spondylitis. I received my first dose of the BNT vaccine in October last year and the second dose in January this year. I would like to ask if the symptoms I describe below could be related to the BNT vaccine. Since be...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question. Here are my responses: 1) Is my chest pain more likely caused by the vaccine or by smoking? --> Ankylosing spondylitis can also cause chest pain, and the likelihood may be higher than the side effects from the vaccine, so it is unlikely to...