Abstract
Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98–72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66–25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42–14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33–19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14–13.09). The occurrence of MACEs was associated with the number of CVRFs (p < 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.
Highlights
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are a heterogeneous group of inflammatory diseases that includes granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome), and is characterized by small vessel necrotizing vasculitis and the presence of autoantibodies targeting either proteinase 3 (PR3) or myeloperoxidase (MPO)
The specific management of cardiovascular risk should combine the control of AAV disease activity and traditional cardiovascular risk factors (CVRFs)
This endothelial dysfunction is more prevalent in AAV patients as compared to the general population [20,21,22], is associated with the presence of inflammation proteins, during vasculitis flares [21,22], and contributes to fibrosis, thrombosis, and atherosclerosis, beginning with preclinical target organ damage followed by overt cardiovascular diseases (CVDs) [23,24]
Summary
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are a heterogeneous group of inflammatory diseases that includes granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome), and is characterized by small vessel necrotizing vasculitis and the presence of autoantibodies targeting either proteinase 3 (PR3) or myeloperoxidase (MPO) It can damage different organs, especially the kidneys; the lungs; the central or peripheral nervous system; the ear, nose, and throat; the skin; the heart. ANCAs may trigger the release of bioactive molecules that have a role in thrombosis, inflammation, and endothelial activation [19] This endothelial dysfunction is more prevalent in AAV patients as compared to the general population [20,21,22], is associated with the presence of inflammation proteins, during vasculitis flares [21,22], and contributes to fibrosis, thrombosis, and atherosclerosis, beginning with preclinical target organ damage followed by overt CVD [23,24]. The aim of our study was to assess the impact of CVRFs on the occurrence of MACEs in AAVs by investigating the relationship between CVRFs and the occurrence of MACEs at 3 years in the prospective OSTEOVAS cohort
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