Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study

Sergey Moiseev; Nikolay Bulanov; Matija Crnogorac; Haner Direskeneli; Kresimir Galesic; Ummugulsum Gazel; Duvuru Geetha; Loic Guillevin; Zdenka Hrušková; Mark A Little; Liam O'Neill; Egor Makarov; Stephen P McAdoo; Aladdin J Mohammad; Sarah Moran; Pavel Novikov; Charles D Pusey; Chinar Rahmattulla; Veronika Satrapová; Joana Silva; Alexander Suvorov; Vladimír Tesar; Benjamin Terrier; Peter Willeit; Ming-Hui Zhao; Andreas Kronbichler; David R W Jayne

doi:10.3899/jrheum.220851

Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study

J Rheumatol. 2023 Sep;50(9):1145-1151. doi: 10.3899/jrheum.220851. Epub 2023 Jan 15.

Authors

Sergey Moiseev¹, Nikolay Bulanov², Matija Crnogorac³, Haner Direskeneli⁴, Kresimir Galesic³, Ummugulsum Gazel⁴, Duvuru Geetha⁵, Loic Guillevin⁶, Zdenka Hrušková⁷, Mark A Little⁸, Liam O'Neill⁹, Egor Makarov¹⁰, Stephen P McAdoo¹¹, Aladdin J Mohammad¹², Sarah Moran¹³, Pavel Novikov², Charles D Pusey¹¹, Chinar Rahmattulla¹⁴, Veronika Satrapová⁷, Joana Silva¹¹, Alexander Suvorov¹⁵, Vladimír Tesar⁷, Benjamin Terrier⁶, Peter Willeit¹⁶, Ming-Hui Zhao¹⁷, Andreas Kronbichler¹⁸, David R W Jayne¹⁹

Affiliations

¹ S. Moiseev, MD, Professor, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, and Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.
² N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.
³ M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia.
⁴ H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey.
⁵ D. Geetha, MD, Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁶ L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France.
⁷ Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
⁸ M.A. Little, MD, Professor, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, and Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland.
⁹ L. O'Neill, MD, University Hospital Galway, Dublin, Ireland.
¹⁰ E. Makarov, MD, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.
¹¹ S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK.
¹² A.J. Mohammad, MD, Department of Rheumatology, Clinical Sciences-Lund, Lund University, Lund, Sweden, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
¹³ S. Moran, MD, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland.
¹⁴ C. Rahmattulla, PhD, Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁵ A. Suvorov, MD, Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁶ P. Willeit, PhD, Professor, Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria, and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
¹⁷ M.H. Zhao, MD, Professor, Renal Division, Peking University First Hospital, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.
¹⁸ A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK. ak2283@cam.ac.uk.
¹⁹ A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK.

PMID: 36642436
DOI: 10.3899/jrheum.220851

Abstract

Objective: To investigate the occurrence of cardiovascular events (CVEs) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, China, Turkey, Russia, the United Kingdom, and the USA.

Methods: Patients with a definite diagnosis of AAV who were followed for ≥ 3 months and had sufficient documentation were included. Data on myocardial infarction (MI) and stroke were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs.

Results: Over a median follow-up of 62.0 months (IQR 22.6-100.0), CVEs (mostly MIs) occurred in 245 (10.7%) of 2286 patients with AAV, with a higher frequency in China and the UK. On multivariate regression analysis, older age (55-64.9 yrs, HR 2.93, 95% CI 1.99-4.31), smoking (HR 1.98, 95% CI 1.48-2.64), Chinese origin (HR 4.24, 95% CI 3.07-5.85), and pulmonary (HR 1.50, 95% CI 1.09-2.06) and kidney (HR 3.02, 95% CI 2.08-4.37) involvement were independent variables associated with a higher occurrence of CVEs.

Conclusion: We showed that geographic region and both traditional and disease-specific (kidney involvement in particular) factors were independently associated with CVEs. Proper assessment and management of modifiable cardiovascular (CV) risk factors are essential for prevention of CV morbidity in patients with AAV.

Keywords: ANCA-associated vasculitis; cardiovascular events; myocardial infarction; risk factors; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Antibodies, Antineutrophil Cytoplasmic*
Humans
Kidney
Retrospective Studies
Risk Factors

Substances

Antibodies, Antineutrophil Cytoplasmic