Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study

Abstract

ObjectiveTo investigate the occurrence of cardiovascular events (CVE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, China, Turkey, Russia, UK, and USA.MethodsPatients with a definite diagnosis of AAV who were followed ≥3 months and had sufficient documentation were included. Data on myocardial infarction (MI) and stroke were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs.ResultsOver a median follow-up of 62 (interquartile range: 23, 100) months, CVE (mostly MI) occurred in 245 (10.7%) of 2286 AAV patients with a higher frequency in China and the UK. On multivariate regression analysis, older age (55-64.9 years; HR 2.93, 95% CI: 1.99, 4.31), smoking (HR 1.98, 95% CI: 1.48, 2.64), Chinese origin (HR 4.24, 95% CI: 3.07, 5.85), pulmonary (HR 1.50, 95% CI: 1.09, 2.06) and kidney (HR 3.02, 95% CI: 2.08, 4.37) involvement were independent variables associated with a higher occurrence of CVE.ConclusionWe showed that geographic region and both traditional and disease specific (kidney involvement in particular) factors were independently associated with CVE. Proper assessment and management of modifiable cardiovascular risk factors are essential for prevention of cardiovascular morbidity in AAV patients.

For Your Eyes Only: 007 Tips for the Management of Cardiovascular Risk Factors in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

“…25 In summary, AAV is clearly associated with increased CVD. The study by Moiseev et al 4 corroborates this and provides evidence that traditional and kidney-specific factors are independently associated with CVD. Although major gaps exist in CVD risk stratification in AAV, both healthcare professionals and patients should be aware that treatment of modifiable risk factors is necessary.…”

“…Indeed, Moiseev et al found that 47.6% of their patients with AAV had hypertension. 4 Whereas immunosuppressive drugs such as mycophenolate mofetil may result in an antihypertensive effect, 17 this was not found for avacopan in the ADVOCATE study. 18 Because of its superior antiproteinuric effect and nephroprotective effect, blockade of the RAAS in combination with (moderate) dietary sodium restriction is the first choice for hypertension treatment in AAV with renal involvement.…”

“…In this issue of The Journal of Rheumatology, Moiseev et al demonstrated that smoking and pulmonary involvement were also associated with an increased risk of CVD. 4 Otherwise, inflammation is also a well-known risk factor of CVD. [1][2][3] Therefore, in AAV, not only is control of disease activity critical to prevent CV events but also the management of modifiable CV risk factors is crucial to prevent CV morbidity and mortality.…”

“…24 Finally, whereas guidelines advocate periodic assessment and treatment of CV risk in AAV, recent studies that evaluate management of CV risk factors demonstrate that current management is still poor. 4,15 This situation is not unique for vasculitis because CV risk management is also a major challenge in other rheumatic diseases such as RA and systemic lupus erythematosus. Although the increased CV risk for CVD in AAV has been known for more than a decade, 1,24 this knowledge has not been implemented in most clinical practices.…”

Prevalence and risk factors of chronic kidney disease in Takayasu arteritis

“…В отличие от системных васкулитов с преимущественным поражением мелких сосудов, АТ обычно не сопровождается развитием гломерулонефрита или тубу- [17]. Помимо этого, высокие темпы прогрессирования атеросклероза, сопровождающегося высоким риском сердечно-сосудистых осложнений, характерны не только для АТ, но и других системных васкулитов, в частности АНЦА-ассоциированных [18][19][20][21].…”