Predictors of fatal and non-fatal cardiovascular events in ANCA-associated vasculitis: Data from the Toronto CanVasc cohort

Eline Houben; Arielle Mendel; Simon Carette; Alexandre E Voskuyl; Erik L Penne; Christian Pagnoux

doi:10.1016/j.jbspin.2019.12.005

Predictors of fatal and non-fatal cardiovascular events in ANCA-associated vasculitis: Data from the Toronto CanVasc cohort

Joint Bone Spine. 2020 May;87(3):221-224. doi: 10.1016/j.jbspin.2019.12.005. Epub 2020 Jan 17.

Authors

Eline Houben¹, Arielle Mendel², Simon Carette², Alexandre E Voskuyl³, Erik L Penne⁴, Christian Pagnoux⁵

Affiliations

¹ Department of Internal Medicine, Northwest Clinics, 1815 JD Alkmaar, The Netherlands; Amsterdam Rheumatology and immunology Centre, Amsterdam UMC-location VUmc, 1081 HV Amsterdam, The Netherlands.
² Department of Rheumatology, Vasculitis clinic, Mount Sinai Hospital, 60, Murray street - Room 2-220, M5T3L9 Toronto, ON, Canada.
³ Amsterdam Rheumatology and immunology Centre, Amsterdam UMC-location VUmc, 1081 HV Amsterdam, The Netherlands.
⁴ Department of Internal Medicine, Northwest Clinics, 1815 JD Alkmaar, The Netherlands.
⁵ Department of Rheumatology, Vasculitis clinic, Mount Sinai Hospital, 60, Murray street - Room 2-220, M5T3L9 Toronto, ON, Canada. Electronic address: Christian.pagnoux@sinaihealthsystem.ca.

PMID: 31958575
DOI: 10.1016/j.jbspin.2019.12.005

Abstract

Objectives: Patients with ANCA-associated vasculitis are at increased risk of cardiovascular events. The aim of the present study was to assess predictors of cardiovascular events in patients with granulomatosis with polyangiitis or eosinophilic granulomatosis with polyangiitis.

Methods: This retrospective cohort study included patients from the Canadian Vasculitis Research Network cohort in Toronto. Characteristics at diagnosis were collected. During follow-up, non-fatal cardiovascular events were determined from the Vasculitis Damage Index; mortality and causes of death were recorded. Cox regression models were developed to determine predictors of cardiovascular events, defined as stroke or myocardial infarction.

Results: A total of 336 patients were included (231 [69%] granulomatosis with polyangiitis; 105 [31%] eosinophilic granulomatosis with polyangiitis). The mean age at diagnosis was 44 (±18) years and 44% were male. The incidence rate for the combined outcome of all fatal and non-fatal events was 7.2 events per 1000 patient-years. In a multivariate model, family history of cardiovascular events and a higher Birmingham Vasculitis Activity Score at diagnosis were predictive of cardiovascular events (hazard ratio and 95% confidence interval 3.46 [1.06-11.28] and 1.09 [1.02-1.16] respectively). In a subgroup analysis there was no association between cardiovascular or disease-specific characteristics and cardiovascular events in eosinophilic granulomatosis with polyangiitis.

Conclusions: In this cohort of patients with granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis, both traditional and disease-related risk factors were predictive of cardiovascular events. Further prospective studies should elucidate the impact of these and other modifiable risk factors on cardiovascular risk in ANCA-associated vasculitis.

Keywords: ANCA-associated vasculitis; Cardiovascular; Cardiovascular events; Myocardial infarction; Stroke.

MeSH terms

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / complications
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / diagnosis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / epidemiology
Antibodies, Antineutrophil Cytoplasmic
Canada / epidemiology
Churg-Strauss Syndrome*
Cohort Studies
Granulomatosis with Polyangiitis* / diagnosis
Granulomatosis with Polyangiitis* / epidemiology
Humans
Male
Prospective Studies
Retrospective Studies

Substances

Antibodies, Antineutrophil Cytoplasmic