Risk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study

Abstract

Objectives To assess the cardiovascular disease (CVD) and venous thromboembolism (VTE) risks among patients with newly diagnosed ANCA-associated vasculitis (AAV). Patients and Methods A population-based incident AAV cohort of 58 patients diagnosed between 1996 and 2015 in Olmsted County (Minnesota, USA) was identified by medical record review. For each patient, 3 age- and sex-matched non-AAV comparators were randomly selected from the same population and assigned an index date corresponding to the AAV incidence date. Medical records of cases and comparators were reviewed for CVD events, which included cardiac events (coronary artery disease, heart failure and atrial fibrillation), cerebrovascular accidents (CVA), peripheral vascular disease (PVD) and VTE, which included deep vein thrombosis (DVT) and pulmonary embolism (PE). Results Baseline total cholesterol, high-density lipoprotein and current smoking rate were lower in AAV than comparators (P=.03, P=.01 and P=.04, respectively), while other CVD risk factors and Framingham risk score were not significantly different between the 2 groups. CVD events developed in 13 patients and 17 comparators, corresponding to a >3 fold increased risk (hazard ratio [HR] 3.15; 95% confidence interval [CI]:1.51-6.57). By subtypes, risks were increased for cardiac events (HR 2.96, 95%CI:1.42-6.15) and CVA (HR 8.16, 95%CI:2.45-27.15), but not for PVD. The HR for VTE was 3.26 (95%CI: 0.84-12.60), significantly increased for DVT (HR 6.25, 95%CI:1.16-33.60), but not for PE (HR 1.33, 95%CI:0.23-7.54). Conclusions Despite a similar prevalence of CVD risk factors at baseline, the risk of CVD is >3 fold higher and for CVA 8-fold higher in patients with incident AAV than matched comparator subjects.

Association of Pulmonary Hemorrhage, Positive Proteinase 3, and Urinary Red Blood Cell Casts With Venous Thromboembolism in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

“…Analysis of a randomized controlled trial that included patients with GPA enrolled in the Wegener's Granulomatosis Etanercept Trial (WGET) demonstrated an incidence of VTE of 7.0 per 100 person‐years . An increased likelihood of VTE was reported in a population‐based incident AAV cohort, which was driven by a significantly increased risk of developing deep venous thrombosis (DVT) . Analysis of a large cohort of patients with eosinophilic granulomatosis with polyangiitis (EGPA), GPA, and MPA demonstrated occurrence of VTE in 8.2%, 8.0%, and 7.8% of patients, respectively .…”

Clinical implication of metabolic syndrome in nonobese patients with antineutrophil cytoplasmic antibody-associated vasculitis

“…Prior to the investigation, it should be noted that except for relapse of AAV, Mets could increase the risks of all-cause mortality [28], chronic kidney disease or ESRD [29], CVA [30] and CVD [28,31,32] in both AAV patients and the general population with MetS. In addition, AAV itself without MetS also could increase the risk for CVD compared to healthy people [14,33]. Therefore, it should not be ignored that both AAV entity and the crosssectional MetS at diagnosis may be simultaneously engaged in CVD occurrence in AAV patients: MetS might significantly initiate CVD occurrence and AAV might accelerate it.…”

Atherogenic index of plasma predicts cerebrovascular accident occurrence in antineutrophil cytoplasmic antibody-associated vasculitis

“…In line with the knowledge that patients with CIDs are at increased risk of developing CVDs, several studies have demonstrated that the risk of CVDs is heightened in AAV patients. A long-term populationbased study revealed that the risk of CVD and CVA in AAV patients were 3-and 8-fold higher than those in matched subjects [22]. In addition, a retrospective study that was performed in the United Kingdom has shown that AAV patients have high incidence of arterial and venous thrombosis [23].…”