Original articleRisk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study
Section snippets
Data Sources
All patients with AAV and comparators were residents of Olmsted County, Minnesota, where the Rochester Epidemiology Project (REP) systematically collects clinical records of all residents seeking medical care. Because of the availability of this comprehensive medical data, the population of Olmsted County is particularly suitable for the investigation of AAV epidemiology.
This record linkage system allows direct access to the medical records of both inpatients and outpatients, from all health
Baseline Characteristics of AAV Cases and Comparators
Baseline demographic and clinical characteristics of AAV cases and comparators are described in Table 1. Median (interquartile range) length of follow-up was 6.5 (2.8-11.3) years for AAV and 6.7 (4.1-8.9) years for comparators. Among the 58 incident AAV cases identified, 48% were women and 98% white, with a mean ± SD age of 61.1±16.5 years. Of the 174 non-AAV comparators, 48% were women and 95% were white, with a mean ± SD age of 61.2±16.3 years. The AAV cases included 23 (40%) GPA, 28 (48%)
Discussion
This population-based study demonstrates that patients with AAV, despite similar baseline CV risk factors and history of prior CVD, are at more than 3 times higher risk for CVD overall compared with the general population, a risk that is more than 4-fold after baseline CVD risk factor adjustment, and at 6 times higher risk for DVT. Moreover, this is the first study to demonstrate a substantially increased incidence of CVA in patients with AAV. This CVD risk is especially increased during the
Conclusion
This long-term follow-up study demonstrates that patients with AAV are at increased risk for any CVD and DVT, with a risk more than 3 times higher for CVD overall, and more than 8 times higher for CVA, compared with matched comparator subjects from the same population. In contrast to some previous reports, the risk of CAD in patients with AAV is not significantly higher than that in the general population when patients with prior CVD events are excluded from the analysis. The risk for CVD in
References (45)
- et al.
Use of a cyclophosphamide-induction methotrexate-maintenance regimen for the treatment of Wegener's granulomatosis: extended follow-up and rate of relapse
Am J Med
(2003) Cardiovascular disease due to accelerated atherosclerosis in systemic vasculitides
Best Pract Res Clin Rheumatol
(2013)- et al.
Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis
Int J Cardiol
(2015) - et al.
Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project
Mayo Clin Proc
(2012) - et al.
History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population
Mayo Clin Proc
(2012) Peripheral arterial disease: pathophysiology, risk factors, diagnosis, treatment, and prevention
J Vasc Nurs
(2009)- et al.
Diagnosis and monitoring of abdominal aortic aneurysm: current status and future prospects
Curr Probl Cardiol
(2010) - et al.
Small-vessel vasculitis
N Engl J Med
(1997) - et al.
ANCA-associated vasculitis— clinical utility of using ANCA specificity to classify patients
Nat Rev Rheumatol
(2016) - et al.
Anticytoplasmic autoantibodies: their immunodiagnostic value in Wegener granulomatosis
Ann Intern Med
(1989)
Factors determining the clinical utility of serial measurements of antineutrophil cytoplasmic antibodies targeting proteinase 3
Arthritis Rheumatol
Antiproteinase 3 antineutrophil cytoplasmic antibodies and disease activity in Wegener granulomatosis
Annals Intern Med
The epidemiology of ANCA associated vasculitis in Olmsted County, Minnesota (USA): a 20 year population-based study
Arthritis Rheumatol
Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody-associated vasculitis
Arthritis Rheum
Rituximab versus cyclophosphamide for ANCA-associated vasculitis
N Engl J Med
Efficacy of remission-induction regimens for ANCA-associated vasculitis
N Engl J Med
Damage caused by Wegener's granulomatosis and its treatment: prospective data from the Wegener's Granulomatosis Etanercept Trial (WGET)
Arthritis Rheum
Risk of myocardial infarction and stroke in patients with granulomatosis with polyangiitis (Wegener's): a population-based study
Arthritis Rheumatol
Increased incidence of cardiovascular events in patients with antineutrophil cytoplasmic antibody-associated vasculitides: a matched-pair cohort study
Arthritis Rheum
Increased morbidity from ischemic heart disease in patients with Wegener's granulomatosis
Arthritis Rheum
Venous thromboembolism in ANCA-associated vasculitis–incidence and risk factors
Rheumatology (Oxford)
Thromboembolic events as a complication of antineutrophil cytoplasmic antibody-associated vasculitis
Arthritis Rheum
Cited by (74)
Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain
2024, Hipertension y Riesgo VascularCardiovascular risk in vasculitis
2023, Best Practice and Research: Clinical RheumatologyRisk of acute myocardial infarction, stroke, and venous thromboembolism among patients with anti-neutrophil cytoplasmic antibody-associated vasculitis in South Korea: A nationwide population-based study
2023, Joint Bone SpineCitation Excerpt :Although an increased risk of thrombotic outcomes has previously been described in autoimmune rheumatic diseases such as rheumatoid arthritis or systemic lupus erythematosus [9–11], data are insufficient on thrombotic outcomes risk in patients with AAV. Several studies have reported inconsistent results regarding the risk of AMI, stroke, or VTE in patients with GPA or MPA [8,12–15]. Furthermore, previous studies evaluating comorbidities in AAV are limited to a small number of cases because of the rarity of the disease and the difficulty with its diagnosis.
Venous Thromboembolism in the Inflammatory Rheumatic Diseases
2023, Rheumatic Disease Clinics of North AmericaSevere Pulmonary Embolism, Thrombosis of Lower Extremity, Unexpected Mild Renal Disorder in MPO-ANCAAssociated Vasculitis: A Case Report
2021, Chinese Medical Sciences Journal
For editorial comment, see page 560
Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, and Jennifer L. St Sauver, PhD ). The work was also supported by Clinical and Translational Science Awards grant UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Potential Competing Interests: The authors have no financial or nonfinancial potential conflicts of interest to declare related to this project. Dr Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France.
Data Previously Presented: This abstract was presented at the last American College of Rheumatology (ACR) 2017 meeting in San Diego, CA.