Background/Purpose:

ANCA-associated vasculitides (AAV) are characterized by inflammation and necrosis of small-sized vessels. Because cardiovascular disease (CVD) is a leading contributor to morbidity and mortality, we assessed the CVD and thrombotic disease risk among newly diagnosed patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) in a US based adult population.

Methods:

Patients with incident AAV in a geographically defined region of the US from January 1, 1996 to December 31, 2015 were previously identified by medical record review. For each incident AAV patient, 3 comparators of similar age and sex without AAV were randomly selected from the same population and assigned an index date corresponding to the AAV incidence date.

Medical records of cases and comparators were reviewed for CVD events which included coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), cerebrovascular accident (CVA), peripheral vascular disease (PVD), and thrombotic non-cardiac vascular events, which included deep vein thrombosis (DVT), and pulmonary embolism (PE). CVD definitions were based on physician diagnosis. Data on baseline CVD risk factors, including smoking status, body mass index, diabetes mellitus, hypertension and dyslipidemia, were also collected. Cox models adjusted for age, sex and calendar year were used for comparisons between groups.

Results:

There were 58 incident cases of AAV (48%, women, 98% Caucasian, mean age 61.1 years) and 174 non-AAV comparators (48% women, 95% Caucasian, mean age 61.2 years). Among cases, 23 (40%) were GPA, 28 (48%) MPA, and 7 (12%) EGPA, mostly ANCA positive (MPO-ANCA 34 [61%], PR3-ANCA17 [30%]).

Baseline total cholesterol (median 179.0 mg/dL for AAV; 191.0 mg/dL for comparators; p=0.026) and current smoking (5% vs 19%; p=0.036) were lower in AAV than comparators, while the other CVD risk factors were not significantly different between the 2 groups. After adjustment for age and sex, hypertension was more frequent in MPA than GPA or EGPA patients at AAV diagnosis (79% vs 43% and 29%, p<0.05).

The prevalence of CVD and thrombotic events before the index date was not significantly different between the 2 groups. During median follow-up of 6.0 years for AAV and 6.7 years for comparators, CVD events developed in 14 AAV patients and 17 comparators corresponding to a >3 fold increased risk of CVD in AAV (hazard ratio [HR] 3.37, 95% confidence interval [CI]:1.64-6.91). By subtypes, risks were elevated for CVA (HR 8.16, 95%CI:2.45-27.15; p<0.001), cardiac events (CAD, HF or AF) (HR 2.95, 95%CI:1.42-6.12; p<0.005), but not PVD. The HR for non-cardiac vascular disease was 3.33 (95% CI: 0.86-12.86), significantly increased for DVT (HR 6.44, 95%CI:1.20-34.66) but not for PE (HR 1.33, 95%CI:0.23-7.60). Increased CVD risks compared to non-AAV were observed in MPA (HR 2.74, 95%CI:1.02-7.35) and MPO-AAV (HR 2.85, 95%CI:1.07- 7.57), but not in GPA or PR3-AAV.

Conclusion:

Despite a lower prevalence of some CVD risk factors at baseline, patients with AAV are at higher risk for incident CVD and DVT following AAV diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-cardiovascular-and-thrombotic-disease-among-patients-with-incident-anca-associated-vasculitis-a-20-year-population-based-cohort-study/