Acute arterial cardiovascular events risk in patients with primary membranous nephropathy
Mohammed Alawami1, Samadhi Wimalasena2, Rajaie Ghashi3
1Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
Background:
Venous thromboembolism is a well established risk in patients with primary membranous nephropathy (MN) due to deficiency in natural anti-coagulants. Recent studies suggested a higher risk of arterial thrombotic events as well in this group.
Aim:
To identify that risk in our cohort.
Methods:
We reviewed the data of all patients who had biopsy proven primary MN at our institute between 2003 and 2013. Clinical data were retrospectively reviewed until November 2016. The cardiovascular (CV) events, including acute coronary syndromes and strokes were determined and included only if occurred after the diagnosis of the nephropathy.
Results:
A total of 204 patients had biopsy proven MN. Follow up information was available for 166 patients. Thirty-one patients (18.6%) developed CV events during follow up. Thirty-eight per cent of total events occurred within 1 year of MN diagnosis. Forty-two per cent of those who developed CV events were not on anti-thrombotic medications and 60% were not on statin therapy. Male gender, age, diabetes and absence of statins therapy were associated with higher rates of CV events in this group.
Conclusion:
There is an increased risk of arterial events in patients with primary MN. This risk is greatest in the first year of diagnosis. The risk should be highlighted in this group of patients and anti-platelets and statin therapy should be considered especially during the initial phase of the disease.
Insights
Patients with primary membranous nephropathy (MN) face a heightened risk of arterial thrombotic events, particularly within the first year post-diagnosis. Early consideration of anti-platelet and statin therapy is recommended for this high-risk group.
Area of Science:
- Nephrology
- Cardiology
- Thrombosis Research
Background:
- Primary membranous nephropathy (MN) is linked to venous thromboembolism due to anticoagulant deficiencies.
- Emerging evidence suggests an elevated risk of arterial thrombotic events in MN patients.
Purpose of the Study:
- To investigate the incidence and risk factors of arterial cardiovascular (CV) events in a cohort of patients with biopsy-proven primary MN.
Main Methods:
- Retrospective review of clinical data for 204 patients with primary MN diagnosed between 2003 and 2013.
- Follow-up data analyzed until November 2016 to identify CV events (acute coronary syndromes, strokes) occurring post-MN diagnosis.
Main Results:
- Of 166 patients with follow-up, 31 (18.6%) experienced CV events, with 38% occurring within the first year of MN diagnosis.
- 42% of patients with CV events were not on anti-thrombotics, and 60% were not on statins.
- Male gender, older age, diabetes, and lack of statin therapy were associated with increased CV event rates.
Conclusions:
- Patients with primary MN have a significantly increased risk of arterial events.
- This risk is most pronounced in the initial year following diagnosis.
- Prophylactic anti-platelet and statin therapy should be considered, especially early in the disease course.
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