Background/Purpose:
Systemic vasculitides are a group of heterogeneous, autoimmune disorders characterized by inflammation of blood vessels. As with other autoimmune disorders, inflammation and long-term medical therapies may lead to accelerated atherosclerosis, with subsequent arterial thrombosis being a significant adverse outcome. Our first goal is to compare the rate of arterial thrombotic events in patients with systemic vasculitis, namely polyarteritis nodosa (PAN) and granulomatosis with polyangiitis (GPA), with that of the general population. Our second goal is to determine if there is an increased rate of comorbidities related to atherosclerosis within the vasculitis group compared to the general population group.
Methods:
Data was collected from the Quebec provincial health administrative database from the years 2002-2006. Incident cases of all systemic vasculitis (ICD 446.x), PAN (ICD 446.0)and GPA (ICD 446.4)were included in the cohort, and age (18-45, >45-<65, and ≥65 years old) and sex-matched controls were taken from the general population. Outcomes included acute myocardial infarction (AMI; ICD 410.x) and cerebrovascular accident (CVA; ICD 433.x, 434.x) which were assessed longitudinally via hospitalization records within the same administrative data. Outcomes in vasculitis cases were compared to those in the general population. Furthermore, the incidence of comorbidities, specifically type II diabetes, hypertension, and dyslipidemia were ascertained in vasculitis patients with adequate followup and compared with the general population.
Results: Within the systemic vasculitis group (n=1672) the incidence rate for AMI was most elevated for 18-45 y.o. females (n=96) at 495.6/100k-py [95% CI 222.7-1103.2] vs. 19.5/100k-py [95% CI 18.6-20.5] in the gen. pop. (relative rate=25.4), and 18-45 y.o. males (n=46) at 1048.8/100k-py [95% CI 471.2-2334.5] vs. 89.5/100k-py [95% CI 87.4-91.6] (RR=11.7). In the PAN/GPA subgroups, similarly elevated rates existed, most significant for young males with PAN at 1683.1/100k-py. The incidence rate for CVA was most elevated in 18-45 y.o. females at 247.2/100k-py vs. 8.8/100k-py (RR=28.1).
Amongst the 45-65 y.o. patients with PAN, there was a RR for AMI of 4.9 in males. In those with GPA, there was no statistical difference in AMI, and a 2-3 RR for CVA. In the ≥65 y.o. group, there was no elevation in RR in any subgroup for either outcome.
In 18-45 y.o. females with systemic vasculitis, there was a incidence of DMII of 10.1% (vs. 0.83% in the gen. pop), dyslipidemia 5.1% (vs. 0.49%), and hypertension 24.1% (vs. 1.37%). In 18-45 y.o. males the incidence of DMII was 7.9% (vs.0.74%), dyslipidemia 13.2% (vs. 1.05%), and hypertension 31.6% (vs.1.46%). In both the 45-65 and ≥65 y.o. groups there was an approximately 2-3 times incidence for the three comorbidities compared to the gen. pop.
Conclusion:
Patients with systemic vasculitis have higher incidence rates of arterial thrombotic events, with the most significant difference seen in subjects under the age of 45 y.o. The high incidence of comorbidities is likely an important factor, possibly related to corticosteroid use. However, the difference in rates observed between PAN and GCA may point to possible disease specific factors.
Disclosure:
A. Tsoukas,
None;
C. A. Pineau,
None;
S. Bernatsky,
None;
L. Joseph,
None;
P. Belisle,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinically-apparent-arterial-thrombosis-in-persons-with-systemic-vasculitis/