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Joint Bone Spine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le dimanche 9 février 2020
Doi : 10.1016/j.jbspin.2019.12.005
Received : 2 September 2019 ;  accepted : 17 December 2019
Predictors of fatal and non-fatal cardiovascular events in ANCA-associated vasculitis: Data from the Toronto CanVasc cohort
 

Eline Houben a, b, Arielle Mendel c, Simon Carette c, Alexandre E. Voskuyl b, Erik L. Penne a, Christian Pagnoux c,
a Department of Internal Medicine, Northwest Clinics, 1815 JD Alkmaar, The Netherlands 
b Amsterdam Rheumatology and immunology Centre, Amsterdam UMC-location VUmc, 1081 HV Amsterdam, The Netherlands 
c Department of Rheumatology, Vasculitis clinic, Mount Sinai Hospital, 60, Murray street – Room 2-220, M5T3L9 Toronto, ON, Canada 

Corresponding author.
Highlights

In a large North American cohort of patients with GPA and EGPA, we found a high incidence of myocardial infarction and stroke.
Cardiovascular events in GPA and EGPA can be explained through a combination of traditional and disease-related risk factors.
The relatively young age in our cohort emphasizes the importance of CV risk and CV risk management in all age categories in GPA and EGPA.

The full text of this article is available in PDF format.
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.

The full text of this article is available in PDF format.

Keywords : ANCA-associated vasculitis, Cardiovascular, Cardiovascular events, Myocardial infarction, Stroke




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