POS-154 ASSOCIATION OF ANCA VASCULITIS AND CARDIOVASCULAR EVENTS: A POPULATION-BASED COHORT STUDY

Abstract

ANCA associated vasculitis (AAV) increases the risk for cardiovascular (CV) disease; whether the elevated risk applies to all types of CV diseases or specific types is unclear. The objective of this study was to examine the association of AAV and adverse CV outcomes compared to the non-AAV population. We conducted a population-based, retrospective cohort study of adults (mean age 61 years, 51% female) with a new diagnosis of AAV in Ontario, Canada from 2007 to 2017. AAV was defined as receiving during a hospital encounter an ICD10 code for AAV (M313 granulomatous polyangiitis, M3131 granulomatous polynagiitis with renal involvement, M317 microscopic polyangiitis, or M301 allergic granulomatous angiitis). The main outcomes were major adverse CV events (MACE defined as myocardial infarction (MI), stroke or CV death), its individual components, atrial fibrillation (AF), and congestive heart failure (CHF), and were ascertained through hospital encounter ICD10 codes. Overlap propensity score weighting along with Cox proportional hazards models accounting for the competing risk of death were used to examine the association of AAV (n=1,520) and CV events in a matched (1:4) control cohort (n=5,834). Study participants were followed until first event of study outcome, death or end of the study period (31st March 2019). Over a mean follow-up of 3.8 years, individuals with AAV had a high cumulative incidence of MACE (15.4%), MI (6.6%), stroke (7.0%), AF (16.4%) and CHF (20.8%). AAV (compared to non-AAV) was not associated with a higher risk of MACE (sub-distribution hazard ratio [sHR] 1.05 95%CI 0.89-1.23), MI (sHR 1.15 95%CI 0.90 -1.47) or CV death (sHR 0.66 95%CI 0.49-0.89) but a higher risk of stroke (sHR 2.92 95%CI 1.76-4.85), AF (sHR 1.51 95%CI 1.30 to 1.75) and CHF (sHR 1.41 95%CI 1.22 to 1.63). The risks for all CV events (except CV death) were significantly elevated in the early period (90 days and 1 year) after AAV diagnosis compared to the non-AAV controls. Table. Cumulative incidences and risks for cardiovascular outcomes Tabled 1Follow-upGroupEvents (%)Cumulative incidence (%)sHR (95% CI)MACEFull studyControl642 (11.0)15.1AAV192 (12.6)15.41.05 (0.89 to 1.23)365-dayControl326 (5.6)5.6AAV126 (8.3)8.31.31 (1.07 to 1.62)90-dayControl162 (2.8)2.8AAV89 (5.9)5.91.87 (1.42 to 2.46)MIFull studyControl234 (4.0)5.8AAV77 (5.1)6.61.15 (0.90 to 1.47)365-dayControl115 (2.0)2.0AAV54 (3.6)3.61.52 (1.10 to 2.10)90-dayControl53 (0.9)0.9AAV42 (2.8)2.82.52 (1.63 to 3.88)Stroke/TIAFull studyControl205 (3.5)5.2AAV85 (5.6)7.01.49 (1.10 to 2.02)365-dayControl85 (1.5)1.5AAV47 (3.1)3.11.87 (1.25 to 2.80)90-dayControl37 (0.6)0.6AAV37 (2.4)2.42.92 (1.76 to 4.85)CV deathFull studyControl285 (4.9)6.2AAV54 (3.6)4.10.66 (0.49 to 0.89)365-dayControl158 (2.7)2.7AAV34 (2.2)2.20.81 (0.55 to 1.20)90-dayControl85 (1.5)1.5AAV17 (1.1)1.10.85 (0.46 to 1.56)AFFull studyControl460 (7.9)11.5AAV205 (13.5)16.41.51 (1.30 to 1.75)365-dayControl236 (4.1)4.1AAV148 (9.7)9.82.06 (1.71 to 2.48)90-dayControl131 (2.3)2.2AAV124 (8.2)8.23.33 (2.66 to 4.18)CHFFull studyControl598 (10.3)13.3AAV240 (15.8)20.81.41 (1.22 to 1.63)365-dayControl350 (6.0)6.0AAV177 (11.6)11.71.75 (1.48 to 2.07)90-dayControl170 (2.9)2.9AAV143 (9.4)9.42.65 (2.15 to 3.26) Open table in a new tab ANCA vasculitis is associated with a high risk of certain types of cardiovascular events, particularly in the early period following diagnosis.