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Published on: October 22, 2014
Early development of new cardiovascular risk factors in the systemic vasculitides
Sara Monti1, Joanna Robson2, Catherine Klersy3
1University of Pavia, Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia; University of Pavia, PhD in Experimental Medicine, Pavia, Italy; and NDORMS, Rheumatology Department, Nuffield Orthopaedic Centre, University of Oxford, UK. sara.saramonti@gmail.com.
Insights
New cardiovascular risk factors like hypertension and diabetes mellitus develop similarly in early stages of anti-neutrophil cytoplasm antibody-associated vasculitis and giant cell arteritis. Renal function and diagnosis type predict these risks, enabling patient stratification.
Area of Science:
- Rheumatology
- Cardiology
- Nephrology
Background:
- Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and giant cell arteritis (GCA) are systemic autoimmune diseases.
- Cardiovascular (CV) risk factors are a significant concern in vasculitis patients.
- Understanding early CV risk factor development is crucial for patient management.
Purpose of the Study:
- To determine the frequency of new-onset cardiovascular risk factors.
- To identify predictors of new-onset hypertension and/or diabetes mellitus (HTN/DM) in AAV and GCA.
- To develop a predictive score for HTN/DM risk in these patients.
Main Methods:
- Analysis of patients from the Diagnostic and Classification of Vasculitis (DCVAS) study.
- Inclusion of patients with AAV (GPA, MPA, EGPA) and GCA, excluding those with pre-existing HTN/DM.
- Statistical analysis to identify predictors and development of a validated risk score.
Main Results:
- New HTN/DM developed within 6 months in 9% of AAV and 6% of GCA patients.
- Predictors included impaired renal function (rise in creatinine/reduced GFR) and anemia (OR 3.98).
- Diagnosis type (MPA, GCA vs. GPA) was also significantly associated with HTN/DM development.
Conclusions:
- New cardiovascular risk factors occur with similar frequency in early AAV and GCA.
- Renal function and diagnosis type are key predictors of HTN/DM.
- A simple predictive score can aid in risk-stratifying patients for early intervention.
Objectives:
To analyse the frequency and predictors of new-onset cardiovascular (CV) risk factors in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and giant cell arteritis (GCA).
Methods:
We analysed the frequency and predictors of new-onset hypertension and/or diabetes mellitus (HTN/DM) amongst patients with AAV or GCA recruited in the Diagnostic and Classification of Vasculitis (DCVAS) study. Patients with pre-existing HTN/DM were excluded.
Results:
We included 873 patients with AAV (506 GPA, 183 MPA, 184 EGPA), and 443 with GCA. Patients with GCA were more likely female (68% vs. 52%; p<0.001) and older (71.33±8.65 vs. 52.80±16.48; p<0.001) compared to patients with AAV. HTN/DM developed within 6 months of diagnosis in 9% of patients with AAV (6% in GPA, 21% in MPA, 3% in EGPA) and 6% of patients with GCA, p=0.15. Rise in creatinine/reduced glomerular filtration rate and/or anaemia (OR 3.98, 95% CI 2.09-7.59, p<0.001) and diagnosis (MPA: OR 2.42, 95%CI 1.52-3.83, p<0.001 and GCA: OR 2.12, 95%CI 1.34-3.38, p=0.001 vs. GPA) were significantly associated with the occurrence of HTN/DM after adjusting for age, sex, ethnicity, and smoking status. We developed and validated a predictive score to discriminate patients according to the risk of developing HTN/DM within 6 months from diagnosis.
Conclusions:
Despite different epidemiological and clinical characteristics, new CV risk factors occur equally in the early stages of AAV and GCA. Renal function and type of diagnosis are associated with the occurrence of HTN/DM. We developed a simple predictive score for the risk-stratification of patients.
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