Background/Purpose: Cardiovascular (CV) events are highly prevalent in patients with systemic necrotizing vasculitides (SNV). The visceral/subcutaneous adipose tissue (VAT/SAT) ratio has been shown to be associated with CV events in various diseases. Using prediction scores, we found elevated VAT/SAT ratios to be associated with higher CV risk in SNV patients. However, no prospective data are available to confirm those findings for incident major CV events (MCVE).

Methods: Patients with ANCA-associated vasculitides or polyarteritis nodosa (PAN) were successively included in a longitudinal study assessing CV complications and other sequelae. At inclusion, DXA evaluation of body composition and abdominal adipose tissue (SAT and VAT) was obtained. Patients were prospectively followed for MCVEs, defined as myocardial infarction, unstable angina, stroke, arterial revascularization and/or hospitalization for or death from CV causes.

Results: Among the 120 patients enrolled (54 men; mean age 53±18 years; median disease duration: 54 months), at inclusion, 28 (23%) had high CV risk, including 16 (13%) with preexisting CV disease, 11 (9%) with diabetes and 9 (8%) with a Framingham CV risk score ≥20%. Age and VAT/SAT ratio were independently associated with high CV risk. Framingham CV risk score was correlated with the VAT/SAT ratio (r²=+0.36, P<0.0001). Also, the high VAT/SAT-ratio tertile (according to gender-specific tertiles) was associated with age and metabolic risk factors.

After median follow-up of 42 months, 19 (16%) patients experienced MCVE: arterial revascularization for 6 (including 4 with myocardial infarction or unstable angina), stroke for 5, hospitalization for CV causes for 5 and 3 CV-caused deaths. The highest VAT/SAT ratio was significantly associated with higher cumulative incident MCVE (P<0.0001; logrank test and logrank test for trend). Hazard ratios (95% CI) for incident MCVE compared with 1^st tertile were 7.22 (1.02-51.3; P=0.048) and 9.90 (3.15-31.2; P=0.0002) in the 2^nd and 3^rd tertile, respectively (Fig). In contrast, age >65 years (HR 1.98 [0.72–5.43]; P=0.19) and body mass index >30 kg/m² (HR 1.37 [0.41–4.61]; P=0.61) were not associated with higher cumulative incident MCVE. The VAT/SAT ratio remained associated with incident MCVEs even for only patients >65 years (P=0.07, logrank test; and P=0.03 logrank test for trend) (Fig).

Conclusion: This study shows a significant association between a high DXA-assessed VAT/SAT ratio and incident MCVE in SNV patients. The VAT/SAT-ratio prognostic value remained significant even for patients >65 years. Abdominal adipose tissue should be probably be evaluated routinely in these patients to assess CV risk.