Background/Purpose: Primary systemic necrotizing vasculitides (SNV) were shown to be associated with more frequent subclinical atherosclerosis, independently of cardiovascular (CV) risk factors and C-reactive protein (CRP) level, suggesting that SNV might be associated with a higher risk of major CV events (MCVE).

Objective : To identify factors predictive of MCVE in SNV patients.

Methods: Consecutive patients in SNV remission were assessed for CV risk factors, body mass index (BMI), CRP levels and subclinical atherosclerosis [ultrasound detection of plaque in peripheral vessels and measurement of carotid intima–media thickness (IMT)], and prospectively followed in the same center. High-risk status, defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III), was a known history of CV disease, diabetes or 10-yr Framingham Risk Score ≥20%. MCVE, defined as myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina and/or death from CV causes, were recorded. Kaplan–Meier MCVE-free survival curves were plotted and compared with the log-rank test.

Results:

Thirty-seven patients (24 males, age 54 ± 15 yr) were followed for 7.0 ± 2.6 yr. SNV diagnoses were: granulomatosis with polyangiitis, 19; eosinophilic granulomatosis with polyangiitis, 8; microscopic polyangiitis, 7; and polyarteritis nodosa, 3. Seven (18.9%) patients suffered MCVE, including myocardial infarction or hospitalization for unstable angina (n=4), arterial revascularization (n=2), and CV cause of death (n=1). The respective 5- and 10-yr MCVE rates were 10.8% and 25.7%.

Univariate analysis selected NCEP/ATP III-defined high-risk status [hazard ratio (HR) 5.02 (95% CI 1.17–27.4), P=0.03], BMI >30 kg/m² [HR 4.84 (95% CI 1.46–116), P=0.02] and plaque detection in the abdominal aorta (P=0.01) as being significantly associated with MCVE. In contrast, SNV characteristics, corticosteroid maintenance therapy, CRP >5 mg/L, and plaque detection in the carotid and femoral arteries were not associated with MCVE. Plaque in the aorta was significantly (χ² test) associated with high-risk status (P<0.001), while BMI and high-risk status were independent variables (P=0.64). Thus, a BMI >30 kg/m² and/or a high-risk status were strongly associated with MCVE (P=0.003).

Finally, although IMT was not associated with MCVE, it distinguished between patients with early or late MCVE: 30% of patients with IMT >0.60 mm (vs none of those with IMT ≤0.60 mm) experienced MCVE within the first 3 yr of follow-up, while 23% of patients with IMT ≤0.60 mm (vs none of those with IMT >0.60 mm) experienced a 1^st MCVE after 7–10 yr of follow-up. IMT was correlated with the time to MCVE (r²=0.78, P=0.008).

Conclusion: These results suggest that factors associated with a higher MCVE risk in SNV patients are NCEP/ATP III-defined high-risk status and BMI >30 kg/m². Carotid IMT measurement in SNV patients could help identify those at risk of early MCVE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-major-cardiovascular-events-in-patients-with-primary-systemic-necrotizing-vasculitides-results-of-a-longitudinal-long-term-follow-up-study/