Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
Studies have shown a strong prevalence of cardiovascular events among patients with primary necrotizing vasculitides. Recent studies indicate that visceral adipose tissue (VAT) is highly associated with insulin resistance and cardiovascular events. Dual energy X-ray absorptiometry (DXA) is a validated technique able to accurately determine cross-sectionally the mass of discreet fat deposits.
Objective. To assess the relevance of abdominal adipose tissue measurement as potential surrogate markers for cardiovascular risk in patients with primary necrotizing vasculitides.
Patients with ANCA-associated vasculitides (AAN) and polyarteritis nodosa (PAN) seen in our department were prospectively included in an ongoing cross-sectional study assessing cardio-vascular complications and other sequelae (OSTEOVAS cohort). Alongside the evaluation of usual clinical and extra-clinical features associated with increased cardiovascular risk, DXA was performed to evaluate body composition and abdominal adipose tissue (subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT).
Sixty-five patients were analyzed (38 females, mean age 50±18 years, mean disease duration of 85±79 months). Diagnoses were granulomatosis with polyangiitis (GPA) in 33 patients, microscopic polyangiitis in 6, eosinophilic GPA in 18, and PAN in 8. Five (7.7%) patients had developed cardiovascular complications. The median daily dose of corticosteroid was 5 mg/day (0-80). High cardiovascular risk defined by the NCEP-ATPIII was found in 11 (16.9%) patients. Using univariate analysis, cumulated dose of corticosteroids (p=0.038), Vascular Damage Index (VDI) (p=0.008), and VAT/SAT ratio (p=0.009) were significantly associated with high cardiovascular risk. Using multivariate analysis, VAT/SAT ratio remained independently associated with high-risk status [OR 1.07 (1.03-1.12), p=0.004]. VAT/SAT ratio was also independently correlated with an increased Framingham cardiovascular risk score (p<0.01).
Among factors correlated with a higher VAT/SAT ratio, we identified male gender (p<0.0001), age (r=+0.31, p=0.014), cumulated corticosteroid dose (r=+0.26, p=0.048), VDI score (r=+0.26, p=0.04), Body Mass Index (r=+0.35, p=0.006), waist circumference (r=+0.56, p<0.0001), and elevated troponin levels at time of assessment (r=+0.36, p=0.007).
This is the first study showing a significant association between a high VAT/SAT ratio assessed by DXA and cardiovascular risk in patients with primary necrotizing vasculitides. Abdominal adipose tissue seems to be an accurate and independent surrogate marker of cardiovascular risk in these patients.
C. Le Jeunne,
L. Guillevin for the French Vasculitis Study Group,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/abdominal-visceral-adipose-tissue-measured-by-dxa-as-a-novel-surrogate-marker-of-cardiovascular-risk-in-primary-necrotizing-vasculitides/