Background Several chronic inflammatory diseases are associated with cardiovascular disease, but the cardiovascular risk in ANCA-associated vasculitis is poorly quantified.
Objectives The aim of the present study is to review the evidence for the increased cardiovascular risk in patients with ANCA-associated vasculitis.
Methods A comprehensive systematic review was conducted in accordance with guidelines of preferred reporting items for systematic reviews and meta-analyses (PRISMA). The databases PubMed, Embase.com and the Cochrane Library (Wiley) were searched for original observational studies reporting an estimate of the association between ANCA-associated vasculitis and cardiovascular events, including ischemic heart disease, cerebrovascular accidents and/or peripheral arterial disease. The quality of the included studies was assessed with the Newcastle–Ottawa Scale. Summary estimates were derived with a random-effects model and reported as relative risks.
Results 1375 studies were identified and 7 studies were included comprising 14098 ANCA-associated vasculitis patients versus general population controls in 6 studies and chronic kidney disease patients in 1 study. ANCA-associated vasculitis carried a relative risk of 1.65 (95% confidence interval, 1.23–2.22) for all cardiovascular events, 1.60 (1.39–1.84) for ischemic heart disease and 1.20 (0.98–1.48) for cerebrovascular accidents. We did not find studies that addressed the risk for peripheral arterial disease separately. No heterogeneity was seen in the estimates.
Conclusions This meta-analysis of observational studies supports an increase in cardiovascular risk of about 65% in patients with ANCA-associated vasculitis, similar to that found in other chronic inflammatory diseases. Hence, there is a clear need for active cardiovascular risk management in patients with ANCA-associated vasculitis.
Disclosure of Interest None declared
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