Traditional and disease-related cardiovascular risk factors in ANCA-associated vasculitis: a prospective, two-centre cohort study

by Selleckchem | Feb 28 2023

Objectives: ANCA-associated vasculitis (AAV) has been associated with increased risk of cardiovascular (CV) events. The aim was to assess traditional and disease-related CV risk determinants in a two-centre prospective cohort of AAV patients.

Methods: Patients were recruited from centres in the Netherlands and Canada. A comprehensive CV risk assessment was performed at inclusion. Subjects were followed up yearly for 3-5 years until the first CV event, death or end of follow-up. Cox proportional hazards analyses were performed to relate baseline characteristics to the first CV event.

Results: A total of 144 patients were included (mean age 62 years, female sex 44%, median Framingham risk score 14.3%). Insulin resistance was present in 73% of patients tested at inclusion, independent of concurrent prednisone therapy. After a median follow-up of 2.90 years, 16 patients (11%) experienced a CV event (14 non-fatal and 2 fatal). The incidence of CV events was 5.45 per 100 patient-years. Age, Framingham risk score, HbA1c level, Diabetes Mellitus (DM), and previous CV event were significantly associated with CV events. Other factors, such as sex, impaired renal function, dyslipidemia, hypertension, smoking history and microalbuminuria, or disease-specific variables, like ANCA serotype or disease activity, were not significantly related to CV events in univariable or age-adjusted cox regression analysis.

Conclusions: Determinants of an increased CV risk were identified. Disease-related factors and treatments can further modify individual risk factors, such as for steroids causing chronic insulin resistance and DM. Treatment of risk factors is essential to optimize long-term outcomes in AAV patients.

Comments：

The study aimed to assess the traditional and disease-related cardiovascular risk factors in patients with ANCA-associated vasculitis (AAV). The study was conducted in two centers in the Netherlands and Canada, and a comprehensive cardiovascular risk assessment was performed at inclusion. The study included 144 patients, with a mean age of 62 years and 44% of them being female. The results showed that insulin resistance was present in 73% of the patients tested at inclusion, independent of concurrent prednisone therapy. After a median follow-up of 2.90 years, 11% of the patients experienced a cardiovascular event, with an incidence of 5.45 per 100 patient-years. The risk factors associated with cardiovascular events were age, Framingham risk score, HbA1c level, Diabetes Mellitus (DM), and previous cardiovascular event. Other factors, such as sex, impaired renal function, dyslipidemia, hypertension, smoking history, and microalbuminuria, or disease-specific variables, like ANCA serotype or disease activity, were not significantly related to cardiovascular events.In conclusion, the study found that age, Framingham risk score, HbA1c level, Diabetes Mellitus (DM), and previous cardiovascular event were significantly associated with cardiovascular events in patients with ANCA-associated vasculitis. The study highlights the importance of treating risk factors to optimize long-term outcomes in AAV patients.