Background ANCA-associated vasculitis (AAVs), including granulomatosis with polyangiitis and microscopic polyangiitis, are small vessel vasculitides. Modern treatments have greatly improved survival in AAV patients, but significant long-term morbidity and mortality such as cardiovascular disease (CVD) are still associated with this disease.
Objectives The aim of our study was to assess the incidence, mortality and predictors of CVD in patients with AAVs
Methods We conducted a retrospective study of AAV diagnosed in Toulouse France teaching hospital between 1981 and 2015. Patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) were included and classified, after thorough medical chart review, according to the criteria proposed by the Chapel Hill Consensus Conference. Eosinophilic granulomatosis with polyangiitis were excuded. A survival analysis was performed. Hazard ratios and the comparative morbidity and mortality figure (CMF) was calculated as the ratio of expected number of deaths in the standard population to those observed as well as predictors of CVD in patients with AAV were also assessed.
Results We identified 361 subjects, only 125 met the inclusion criteria, 99 GPA and 26 MPA, 65 (42%) were men and mean age was 61.3±15.7 years at CVD occurrence with a mean follow-up of 88.4±78.3 months since diagnosis.Coronary artery disease (CAD) developed in 10 patients, and ischemic stroke developed in 9 patients (incidence rates of 8.5 per 1,000 person-years and 10.2 per 1,000 person-years, respectively). CAD incidence for AAV patients is two times more than in the general population, independent of age differences between the two populations using the Midi-Pyrénées county CAD registry as a reference (CMF of 1.96; 95CI 0.88 to 4.36). Ischemic stroke incidence for AAV patients is three times more than in the general population, independent of age differences between the two populations (CMF of 3.36; 95CI 1.75 to 6.46).
Smoking habits and history of CAD at AAV diagnosis was strongly associated with CAD occurrence (adjusted HR 8.8; 95CI 2.12 to 36.56, p=0.003 and adjusted HR 10.3; 95CI 1.02 to 104.5, p=0.003, respectively). An ENT flare (adjusted HR 0.12) was a independent protective factor for CAD occurrence. We did not find any statistically significant associated factor with ischemic stroke occurrence in our cohort.
Using direct standardisation, the age adjusted mortality rate for the AAV cohort was 22.5 per 1,000 person-years and for the general population 10.2 per 1,000 person-years. This indicates that mortality for AAV patients is one and a half times more than in the general population, independent of age differences between the two populations (CMF of 1.56; 95CI 1.02 to 2.39).
Conclusions Patients with AAV have a significantly increased risk of mortality and ischemic stroke and a non–statistically significant trend toward an increased risk of CAD. Monitoring for this complication and vigilance in modifying risk factors are particularly warranted in this patient population.
Disclosure of Interest None declared