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Comment
. 2021 Nov 24;15(4):681-692.
doi: 10.1093/ckj/sfab229. eCollection 2022 Apr.

Association of anti-neutrophil cytoplasmic antibody-associated vasculitis and cardiovascular events: a population-based cohort study

David Massicotte-Azarniouch  1 , William Petrcich  2 , Michael Walsh  3 , Mark Canney  4 , Gregory L Hundemer  4 , Nataliya Milman  5 , Michelle A Hladunewich  6 , Todd Fairhead  4 , Manish M Sood  2
Affiliations
Comment

Association of anti-neutrophil cytoplasmic antibody-associated vasculitis and cardiovascular events: a population-based cohort study

David Massicotte-Azarniouch et al. Clin Kidney J. .

Abstract

Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is implicated in elevating the risk for cardiovascular (CV) disease; whether the elevated risk applies to all types of CV diseases or specific types is unclear. This study examined the association of AAV and adverse CV outcomes compared with the non-AAV population.

Methods: We conducted a population-based, retrospective cohort study of adults (mean age 61 years, 51% female) with a new diagnosis of AAV in Ontario, Canada from 2007 to 2017. Weighted models were used to examine the association of AAV (n = 1520) and CV events in a matched (1:4) control cohort (n = 5834). The main outcomes were major adverse CV events (MACE), defined as myocardial infarction (MI), stroke or CV death, its components, atrial fibrillation (AF) and congestive heart failure (CHF).

Results: Over a mean follow-up of 3.8 years, AAV (compared with non-AAV) was associated with a higher risk of stroke: cumulative incidence 7.0% versus 5.2%, sub-distribution hazard ratio (sHR) 1.49 [(95% confidence interval (95% CI) 1.10-2.02]; AF: cumulative incidence 16.4% versus 11.5%, sHR 1.51, 95% CI 1.30-1.75; and CHF: cumulative incidence 20.8% versus 13.3%, sHR 1.41, 95% CI 1.22-1.62; but not for MACE, MI or CV death. The risks for all CV events, except CV death, were significantly elevated in the early period after AAV diagnosis, in particular AF (365-day sHR 2.06, 95% CI 1.71-2.48; 90-day sHR 3.33, 95% CI 2.66-4.18) and CHF (365-day sHR 1.75, 95% CI 1.48-2.07; 90-day sHR 2.65, 95% CI 2.15-3.26).

Conclusion: AAV is associated with a high risk of certain types of CV events, particularly in the early period following diagnosis.

Keywords: ANCA-associated vasculitis; atrial fibrillation; cardiovascular events; congestive heart failure.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Study flow chart. Flow chart of cohort creation for the study project, with inclusion and exclusion criteria, from target population, to source population and then exposure and control group populations.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves and forest plots with adjusted risks for outcomes. Cumulative incidence curves for each CV outcome by AAV status, along with forest plots of the sHR or outcomes in AAV group for 90-day, 365-day and full-study follow-up time. The sHR are adjusted for index year due to imbalances in this baseline characteristics between the two groups despite overlap propensity weighting. (A) MACE; (B) MI; (C) stroke/TIA; (D) CV death; (E) AF; (F) CHF.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves and forest plots with adjusted risks for outcomes. Cumulative incidence curves for each CV outcome by AAV status, along with forest plots of the sHR or outcomes in AAV group for 90-day, 365-day and full-study follow-up time. The sHR are adjusted for index year due to imbalances in this baseline characteristics between the two groups despite overlap propensity weighting. (A) MACE; (B) MI; (C) stroke/TIA; (D) CV death; (E) AF; (F) CHF.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves and forest plots with adjusted risks for outcomes. Cumulative incidence curves for each CV outcome by AAV status, along with forest plots of the sHR or outcomes in AAV group for 90-day, 365-day and full-study follow-up time. The sHR are adjusted for index year due to imbalances in this baseline characteristics between the two groups despite overlap propensity weighting. (A) MACE; (B) MI; (C) stroke/TIA; (D) CV death; (E) AF; (F) CHF.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves and forest plots with adjusted risks for outcomes. Cumulative incidence curves for each CV outcome by AAV status, along with forest plots of the sHR or outcomes in AAV group for 90-day, 365-day and full-study follow-up time. The sHR are adjusted for index year due to imbalances in this baseline characteristics between the two groups despite overlap propensity weighting. (A) MACE; (B) MI; (C) stroke/TIA; (D) CV death; (E) AF; (F) CHF.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves and forest plots with adjusted risks for outcomes. Cumulative incidence curves for each CV outcome by AAV status, along with forest plots of the sHR or outcomes in AAV group for 90-day, 365-day and full-study follow-up time. The sHR are adjusted for index year due to imbalances in this baseline characteristics between the two groups despite overlap propensity weighting. (A) MACE; (B) MI; (C) stroke/TIA; (D) CV death; (E) AF; (F) CHF.
FIGURE 2:
FIGURE 2:
Cumulative incidence function curves and forest plots with adjusted risks for outcomes. Cumulative incidence curves for each CV outcome by AAV status, along with forest plots of the sHR or outcomes in AAV group for 90-day, 365-day and full-study follow-up time. The sHR are adjusted for index year due to imbalances in this baseline characteristics between the two groups despite overlap propensity weighting. (A) MACE; (B) MI; (C) stroke/TIA; (D) CV death; (E) AF; (F) CHF.
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