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Traditional and disease-related cardiovascular risk factors in ANCA-associated vasculitis: A prospective, two-centre
Yosta Vegting1, Erik L Penne2, Marc L Hilhorst3
1Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands; Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands; Amsterdam institute for Infection and Immunity, Inflammatory diseases, Amsterdam, The Netherlands.
Insights
ANCA-associated vasculitis (AAV) patients face higher cardiovascular risks. Age, diabetes, and prior events predict these risks, highlighting the need for proactive management of cardiovascular health in AAV.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- ANCA-associated vasculitis (AAV) is linked to increased cardiovascular (CV) event risk.
- Understanding CV risk factors in AAV is crucial for patient outcomes.
Purpose of the Study:
- To assess traditional and disease-related CV risk determinants in AAV patients.
- To identify factors associated with CV events in a prospective AAV cohort.
Main Methods:
- Prospective cohort study in the Netherlands and Canada.
- Comprehensive CV risk assessment at inclusion.
- Follow-up for 3-5 years, analyzing CV events using Cox regression.
Main Results:
- 144 AAV patients (mean age 62) were included; 11% experienced CV events over 2.9 years.
- Insulin resistance was prevalent (73%).
- Age, Framingham risk score, HbA1c, diabetes, and prior CV events were significant predictors of CV events.
Conclusions:
- Identified key determinants of increased CV risk in AAV.
- Disease-related factors and treatments (e.g., steroids) can exacerbate risk factors like insulin resistance and diabetes.
- Aggressive management of CV risk factors is essential for improving long-term outcomes in AAV patients.
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.
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