Blood fat indices linked to early artery damage in spondyloarthritis patients

Patients with spondyloarthritis face a heightened risk of cardiovascular disease that traditional risk factors alone cannot fully explain, and a new cross-sectional study suggests that composite atherogenic lipid indices may help flag the earliest vascular changes in this population. The research, published open access in BMC Rheumatology on 19 September 2026 by Miroslav Markov, Tsvetoslav Georgiev, Maria Dimova and Simona Bogdanova, examined how a battery of blood-fat measures relates to carotid artery thickness and stiffness measured at the vessel wall itself.

The team enrolled 150 patients with spondyloarthritis, including 109 with ankylosing spondylitis and 41 with psoriatic arthritis. Each participant underwent lipid profiling covering the atherogenic index of plasma (AIP), Castelli risk indices I and II, non-high-density lipoprotein cholesterol (non-HDL-C) and the atherogenic coefficient, alongside standard fractions such as LDL-C and HDL-C. Subclinical atherosclerosis and arterial stiffness were assessed with carotid ultrasonography using echo-tracking technology, yielding carotid intima-media thickness (CIMT) plus local carotid pulse wave velocity, β-stiffness, pressure-strain elastic modulus, arterial compliance and the augmentation index. Associations were tested with Spearman correlation and multivariable linear regression.

Triglycerides stood out as the most consistent signal. They correlated with CIMT (ρ = 0.241, p = 0.003), β-stiffness (ρ = 0.314, p < 0.001), local carotid pulse wave velocity (ρ = 0.325, p < 0.001) and the pressure-strain elastic modulus (ρ = 0.318, p < 0.001). Non-HDL-C also correlated significantly with CIMT (ρ = 0.248, p = 0.002), β-stiffness (ρ = 0.195, p = 0.017), local carotid pulse wave velocity (ρ = 0.249, p = 0.002) and the elastic modulus (ρ = 0.225, p = 0.006). AIP correlated positively with CIMT, β-stiffness, local carotid pulse wave velocity and the elastic modulus.

After multivariable adjustment, two indices retained independent associations. AIP remained linked to local carotid pulse wave velocity (B = 0.534, 95% CI 0.005–1.063; β = 0.150, p = 0.048), while non-HDL-C remained linked to CIMT (B = 0.027, 95% CI 0.002–0.053; β = 0.149, p = 0.033). In contrast, LDL-C and HDL-C showed only limited associations with the vascular parameters measured.

The authors conclude that atherogenic lipid indices are associated with carotid structural and functional vascular parameters in spondyloarthritis, and that non-HDL-C and AIP were independently associated with CIMT and PWV respectively, suggesting these indices may add complementary information about vascular characteristics in this patient group. The findings align with the study’s framing of the lipid paradox, in which chronic inflammation may alter lipid metabolism and blunt the value of conventional lipid measures for cardiovascular risk assessment in inflammatory disease.

Because the design is cross-sectional, the results demonstrate associations rather than causal effects, and the modest correlation coefficients indicate that atherogenic indices capture only part of the variation in vascular measures.

Subject of Research: Associations between atherogenic lipid indices and subclinical carotid atherosclerosis and arterial stiffness in spondyloarthritis

Article Title: Atherogenic lipid indices are associated with carotid intima-media thickness and local carotid stiffness parameters in spondyloarthritis: a cross-sectional study

Article References: Markov, M., Georgiev, T., Dimova, M., & Bogdanova, S. (2026). Atherogenic lipid indices are associated with carotid intima-media thickness and local carotid stiffness parameters in spondyloarthritis: a cross-sectional study. BMC Rheumatology. https://doi.org/10.1186/s41927-026-00697-x

Image Credits: AI Generated

DOI: 10.1186/s41927-026-00697-x

Keywords: spondyloarthritis, atherogenic lipid indices, carotid intima-media thickness, arterial stiffness, pulse wave velocity, non-HDL cholesterol, atherogenic index of plasma, triglycerides, cardiovascular risk, cross-sectional study, rheumatology, echo-tracking ultrasonography