Original article
Risk of Cardiovascular Disease and Venous Thromboembolism Among Patients With Incident ANCA-Associated Vasculitis: A 20-Year Population-Based Cohort Study

https://doi.org/10.1016/j.mayocp.2018.02.010Get rights and content

Abstract

Objective

To assess the cardiovascular disease (CVD) and venous thromboembolism (VTE) risks among patients with newly diagnosed antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV).

Patients and Methods

A population-based incident AAV cohort of 58 patients diagnosed between 1996 and 2015 in Olmsted County, MN, was identified by medical record review. For each patient, 3 age- and sex-matched non-AAV comparators were randomly selected from the same population and assigned an index date corresponding to the AAV incidence date. Medical records of cases and comparators were reviewed for CVD events, which included cardiac events (coronary artery disease, heart failure, and atrial fibrillation), cerebrovascular accidents (CVA), peripheral vascular disease (PVD), and VTE, which included deep vein thrombosis (DVT) and pulmonary embolism (PE).

Results

Baseline total cholesterol, high-density lipoprotein, and current smoking rate were lower in AAV than in comparators (P=.03, P=.01, and P=.04, respectively), whereas other CVD risk factors and Framingham risk score were not significantly different between the 2 groups. The CVD events developed in 13 patients and 17 comparators, corresponding to a more than 3-fold increased risk (hazard ratio [HR], 3.15; 95% CI, 1.51-6.57). By subtypes, risks were increased for cardiac events (HR, 2.96; 95% CI, 1.42-6.15) and CVA (HR, 8.16; 95% CI, 2.45-27.15), but not for PVD. The HR for VTE was 3.26 (95% CI, 0.84-12.60), significantly increased for DVT (HR, 6.25; 95% CI, 1.16-33.60), but not for PE (HR, 1.33; 95% CI, 0.23-7.54).

Conclusion

Despite a similar prevalence of CVD risk factors at baseline, the risk of CVD is more than 3-fold higher and for CVA 8-fold higher in patients with incident AAV than in matched comparator subjects.

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

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    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.

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