Impact of Cardiovascular Risk Factors on the Occurrence of Cardiovascular Events in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitides

Abstract

Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98-72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66-25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42-14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33-19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14-13.09). The occurrence of MACEs was associated with the number of CVRFs (p < 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.

Keywords: antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis; cardiovascular risk; cardiovascular risk factors; dyslipidemia; hypertension; sedentary lifestyle.

Figure 1

Odds ratios of presenting a major cardiovascular event during follow-up for each cardiovascular risk factor and CRP from the OSTEOVAS cohort. The multivariate analysis was adjusted for the use of glucocorticoids and cyclophosphamide. CRP, C-reactive protein; CVD, cardiovascular disease; OR, odds ratio; MACEs, major cardiovascular events; age by gender: being >50 years for men and >60 years for women.