RESEARCH - Increased incidence of cardiovascular events in patients with AAVs

[Guest guest]

Arthritis Rheum. 2009 Nov;60(11):3493-500.

Increased incidence of cardiovascular events in patients with

antineutrophil cytoplasmic antibody-associated vasculitides: a

matched-pair cohort study.

MD, Turnbull J, Selamet U, Kaur-Hayer M, Nightingale P, Ferro

CJ, Savage CO, Harper L.

University of Birmingham, Birmingham, UK.

OBJECTIVE: To explore the risk of cardiovascular disease in patients

with antineutrophil cytoplasmic antibody-associated vasculitides

(AAVs) and to assess contributing risk factors.

METHODS: In a retrospective matched-pair cohort study, 113 of 131

patients with AAVs from a vasculitis clinic registry were matched 1:1

for renal function, age at diagnosis, sex, smoking status, and

previous history of a cardiovascular disease to patients with

noninflammatory chronic kidney disease (CKD). Cardiovascular events

were defined as acute coronary syndrome, new-onset angina, symptomatic

peripheral vascular disease, stroke, and transient ischemic attack.

RESULTS: Median followup times were 3.4 years for the AAV patients and

4.2 years for the CKD patients. More cardiovascular events occurred in

the AAV group (23 of 113) than in the CKD group (16 of 113).

regression survival analysis showed a significantly increased risk of

a cardiovascular event for AAV patients, with a hazard ratio (HR) of

2.23 (95% confidence interval [95% CI] 1.1-4.4) (P = 0.017). Within

the cohort of AAV patients, the most strongly predictive factors were

previous history of cardiovascular disease (HR 4 [95% CI 1.7-9.8]),

history of dialysis dependency (HR 4.3 [95% CI 1.5-12.1]), ever having

smoked (HR 3.9 [95% CI 1.5-10]), age at diagnosis (HR 1.038 [95% CI

1.006-1.072]), estimated glomerular filtration rate at remission (HR

0.977 [95% CI 0.957-0.998]), and serum cholesterol concentration at

presentation (HR 0.637 [95% CI 0.441-0.92]).

CONCLUSION: In this retrospective study, patients with AAVs appear at

greater risk of cardiovascular disease, with increased risk in those

with a previous history of cardiovascular disease, dialysis

dependency, poor renal function at remission, or a history of smoking.

Measures to reduce the risk of cardiovascular disease should be

integral to the management of systemic vasculitis.

PMID: 19877070

http://www.ncbi.nlm.nih.gov/pubmed/19877070

Not an MD