Assessment of cardiovascular risk in patients with ANCA-associated vasculitis: A systematic review and meta-analysis

Abstract

BackgroundAlthough many chronic inflammatory conditions are linked to elevated cardiovascular risk, the specific extent of this risk in ANCA-associated vasculitis (AAV) remains elusive, largely due to the disease's rarity. Our study sought to clarify the cardiovascular risks and mortality linked to AAV. MethodsA systematic literature review was conducted across multiple databases from their inception until April 2024 to identify studies comparing cardiovascular outcomes in patients with and without AAV. R Studio's meta package was used to pool risk ratios under the random-effects model, and statistical significance was set at p < 0.05. ResultsNine observational studies involving 45024 individuals were included in this analysis. Patients with AAV exhibited a significantly elevated risk of stroke (RR = 1.43, 95 % CI: 1.12–1.83, I2 = 62 %, p = 0.0048), myocardial infarction (RR = 1.49, 95 % CI: 1.25–1.79, I2 = 0 %, p < 0.0001), ischemic heart disease (RR = 1.40, 95 % CI: 1.24–1.58, I2 = 1 %, p < 0.0001), venous thromboembolism (RR = 2.57, 95 % CI: 1.70–3.90, I2 = 74 %, p < 0.0001), and pulmonary embolism (RR = 3.53, 95 % CI: 2.82–4.42, I2 = 9 %, p < 0.0001), deep vein thrombosis (RR: 4.21; 95 % CI: 2.00–8.86; p = 0.0002), heart failure (RR = 1.63, 95 % CI: 1.39–1.90, I2 = 0 %, p < 0.0001), and cardiovascular disease-related mortality (RR = 1.79, 95 % CI: 1.07–3.00, I2 = 0 %, p = 0.0256) compared to patients without AAV. ConclusionThis meta-analysis underscores a notable increase in adverse cardiovascular events among patients with AAV, underscoring the need for comprehensive cardiovascular care and diligent monitoring in this patient cohort.