Background Primary systemic necrotizing vasculitides (SNV) were shown to be associated with more frequent subclinical atherosclerosis, independently of cardiovascular (CV) risk factors and C-reactive protein (CRP) level, suggesting that SNV might be associated with a higher risk of major CV events (MCVE).
Objectives To identify factors predictive of MCVE in SNV patients.
Methods Consecutive patients in SNV remission were assessed for CV risk factors, body mass index (BMI), CRP levels and subclinical atherosclerosis [ultrasound detection of plaque in peripheral vessels and measurement of carotid intima–media thickness (IMT)], and prospectively followed in the same center. High-risk status, defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III), was a known history of CV disease, diabetes or 10-yr Framingham Risk Score ≥20%. MCVE, defined as myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina and/or death from CV causes, were recorded. Kaplan–Meier MCVE-free survival curves were plotted and compared with the log-rank test.
Results Thirty-seven patients (24 males, age 54 ± 15 yr) were followed for 7.0 ± 2.6 yr. SNV diagnoses were: granulomatosis with polyangiitis, 19; eosinophilic granulomatosis with polyangiitis, 8; microscopic polyangiitis, 7; and polyarteritis nodosa, 3. Seven (18.9%) patients suffered MCVE, including myocardial infarction or hospitalization for unstable angina (n=4), arterial revascularization (n=2), and CV cause of death (n=1). The respective 5- and 10-yr MCVE rates were 10.8% and 25.7%.
Univariate analysis selected NCEP/ATP III-defined high-risk status [hazard ratio (HR) 5.02 (95% CI 1.17–27.4), P=0.03], BMI >30 kg/m2 [HR 4.84 (95% CI 1.46–116), P=0.02] and plaque detection in the abdominal aorta (P=0.01) as being significantly associated with MCVE. In contrast, SNV characteristics, corticosteroid maintenance therapy, CRP >5 mg/L, and plaque detection in the carotid and femoral arteries were not associated with MCVE. Plaque in the aorta was significantly (X2test) associated with high-risk status (P<0.001), while BMI and high-risk status were independent variables (P=0.64). Thus, a BMI >30 kg/m2 and/or a high-risk status were strongly associated with MCVE (P=0.003).
Finally, although IMT was not associated with MCVE, it distinguished between patients with early or lateMCVE: 30% of patients with IMT >0.60 mm (vs none of those with IMT ≤0.60 mm) experienced MCVE within the first 3 yr of follow-up, while 23% of patients with IMT ≤0.60 mm (vs none of those with IMT >0.60 mm) experienced a 1st MCVE after 7–10 yr of follow-up. IMT was correlated with the time to MCVE (r2=0.78, P=0.008).
Conclusions These results suggest that factors associated with a higher MCVE risk in SNV patients are NCEP/ATP III-defined high-risk status and BMI >30 kg/m2. Carotid IMT measurement in SNV patients could help identify those at risk of early MCVE.
Disclosure of Interest: None Declared