Background/Purpose: Current treatment approaches have greatly improved the survival of eosinophilic granulomatosis with Polyangiitis (EGPA) patients, however both morbidity andmortality are still significant mainly due to cardiovascular complications.Premature and accelerated atherosclerosis has emerged as an important facet of ANCA associated vasculitis (AAV) cardiovascular risk but, eosinophil infiltration could also be responsible of endomyocardial damage and direct vascular injury in EGPA. Several studies showed a higher frequency of cardiovascular disease in patients with AAV or granulomatosis with polyangiitis but data on cardiovascular disease risk in EGPA patients are scarce. The aim of our study was to assess acute coronary artery disease and ischemic stroke, incidence and predictors, in eosinophilic granulomatosis with Polyangiitis(EGPA).

Methods: We conducted a retrospective cohort study of all EGPA, diagnosed between 1982 and 2018, who met Chapel Hill Consensus Conference classification criteriaafter thorough medical chart review. Major cardiovascular eventwas defined as acute coronary artery disease or ischemic stroke. We calculated the comparative morbidity/mortality figure (CMF)and we used Cox proportional hazards regression models to assess the risk of acute coronary artery disease, ischemic stroke associated with EGPA, after adjusting for covariates.

Results: We identified 67 subjects, only 55 met the inclusion criteria, 29 (55%) were men, with a mean follow-up of 8.1 ±7.7 years since EGPA diagnosis.

Acute coronary artery disease occurred in 9 patients, and ischemic stroke occurred in 2 patients (incidence rates of 21.1 per 1,000 person-years and 4.3 per 1,000 person-years, respectively). Using direct standardization, acute coronary artery diseaseincidence was seven times higher than in the general population (CMF 7.20; 95% CI 6.46 – 14.72) and, ischemic stroke incidence was tree times higher than in the general population (CMF 3.74; 95% CI 3.40 – 13.09). Age over 58 years and purpura were independently associated with coronary artery disease occurrence (adjusted HR 13.3; 95% CI 1.6 – 107.9, and adjusted HR 4.1; 95% CI 1.0 – 16.1, respectively). We did not identify factors significantly associated with ischemicstroke occurrence. In our cohort, none of the classic cardiovascular risk factors were associated with an increased risk of acute coronary artery disease or ischemic strokeoccurrence. Using direct standardization, the age-adjusted overall mortality rate was 8.9 per 1000 person-years and was not different than the general population.

Conclusion: EGPA have a significantly increased risk of acute coronary artery disease and ischemic stroke. Monitoring for these complications and attempts strict management of cardiovascular risk factors are warranted in this population as part of the long-term management of this condition.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-acute-coronary-artery-disease-and-ischemic-stroke-in-patients-with-eosinophilic-granulomatosis-with-polyangiitis/