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Increased ischemic stroke, acute coronary artery disease and mortality in patients with granulomatosis with
M Mourguet1, D Chauveau2, S Faguer2
1Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne, CHU Toulouse Purpan, Toulouse, France.
Insights
Patients with ANCA-associated vasculitis (AAV) face significantly higher risks of major cardiovascular events, including ischemic stroke and coronary artery disease. Mortality rates are also elevated in AAV patients compared to the general population.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Epidemiology
Background:
- ANCA-associated vasculitis (AAV) encompasses severe systemic autoimmune diseases.
- Cardiovascular complications represent a significant cause of morbidity and mortality in AAV patients.
- Understanding cardiovascular event incidence and predictors in AAV is crucial for patient management.
Purpose of the Study:
- To evaluate the incidence of major cardiovascular events (MCEs) in patients diagnosed with Granulomatosis with Polyangiitis (GPA) or Microscopic Polyangiitis (MPA).
- To identify predictors associated with cardiovascular disease occurrence in AAV.
- To assess the overall mortality risk in AAV patients.
Main Methods:
- Retrospective cohort study of GPA and MPA patients diagnosed between 1981 and 2015.
- MCEs defined as acute coronary artery disease, ischemic stroke, or revascularization for peripheral vascular disease.
- Cox proportional hazards regression models were used to analyze risk factors for cardiovascular events and mortality.
Main Results:
- Ischemic stroke and coronary artery disease incidence were approximately four times higher in AAV patients than in the general population.
- Smoking and prior coronary artery disease history were significant risk factors for coronary artery disease.
- Overall mortality was 1.5 times higher in AAV patients compared to the general population.
Conclusions:
- ANCA-associated vasculitis is associated with a substantially increased risk of mortality, ischemic stroke, and coronary artery disease.
- Proactive cardiovascular risk management is essential for patients with AAV.
- Further research into protective factors, such as ENT flare-ups, may offer therapeutic insights.
Objective:
The aim of our study was to assess major cardiovascular event incidence, predictors, and mortality in ANCA-associated vasculitis (AAV).
Methods:
We conducted a retrospective cohort study of all GPA or MPA, according to Chapel Hill Consensus Conference classification criteria, diagnosed between 1981 and 2015. Major cardiovascular event was defined as acute coronary artery disease, or ischemic stroke, or peripheral vascular disease requiring a revascularization procedure. We calculated the comparative morbidity/mortality figure (CMF) and we used Cox proportional hazards regression models to assess the risk of coronary artery disease, ischemic stroke associated with AAV, after adjusting for covariates.
Results:
125 patients, 99 GPA (79,2%) and 26 MPA (20,8%), were followed 88.4 ± 78.3 months. Ischemic stroke incidence was four times higher than in the general population (CMF 4,65; 95% CI 4,06-5,31). Coronary artery disease incidence was four times higher than in the general population (CMF 4,22; 95% CI 1,52-11,68). Smoking habits and history of coronary artery disease were strongly associated with coronary artery disease occurrence (adjusted HR 8.8; 95% CI 2.12-36.56, and adjusted HR 10.3; 95% CI 1.02-104.5, respectively). ENT flare-up was an independent protective factor for coronary artery disease occurrence. We did not identify factors significantly associated with stroke occurrence. The age-adjusted mortality rate was 22.5 per 1000 person-years. Mortality in AAV was 1.5 times higher than in the general population (CMF 1.56; 95% CI 1.34-1.83).
Conclusion:
AAV have a significantly increased risk of mortality, ischemic stroke, and coronary artery disease.
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