Patients with antineutrophilic cytoplasmic antibody-associated vasculitis (AAV) are at increased risk of developing cardiovascular disease (CVD) during the year prior to diagnosis, according to study results published in Rheumatology (Oxford).
Investigators assessed whether patients with AAV are at increased risk for CVD during the months preceding their diagnosis.
A retrospective, nested case-control study was conducted, including patients with AAV
registered in the Danish National Patient Registry as having granulomatosis with polyangiitis or microscopic polyangiitis. Each patient with AAV was age- and sex-matched with 3 patients free of disease (control group). Patients with AAV and their matched counterparts were given the same index date, defined as the first hospital or clinic visit with a diagnosis of AAV.
The primary study outcome was a composite of all cardiovascular outcomes, defined having a “cardiovascular history” according to medical records.
The risk for major adverse cardiovascular events (MACE) including stroke, acute myocardial infarction or revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery was also assessed.
A total of 2371 patients with AAV and 7113 members of the control group were included in the analysis. The median patient age among both groups was 63 years and nearly 54% were men.
The prevalence of any cardiovascular outcome was 10.3% among patients with AAV compared with 3.8% among the control group (hazard ratio [HR], 3.05; 95% CI, 2.48-3.75) within the 12 months prior to the index date.
The prevalence of MACE was 2.4% among patients with AAV compared with 1.3% among the control group (HR, 1.98; 95% CI, 1.39-2.82) within the 12 months prior to the index date.
The risks for any cardiovascular outcome and MACE increased temporally, as the time until index date and subsequent AAV diagnosis decreased. These risks peaked 1 month prior to index date for any cardiovascular outcome (HR, 10.73; 95% CI, 7.05-16.32) and MACE (HR, 5.78; 95% CI, 2.67-12.52).
When individual cardiovascular outcomes were considered separately, patients with AAV were found to be at greater risk for all outcomes, with the exception of ventricular arrhythmias/implantable cardioverter-defibrillator-implantation/cardiac arrest.
Study limitations included potential AAV diagnostic delay and residual confounding due to the inability to account for patients’ lifestyle factors that may increase their risk of developing CVD.
The study authors concluded, “Based on these findings, the initial period preceding AAV diagnosis should be considered as a “high-risk window” for developing cardiovascular disease and thus the importance of early clinical vigilance toward cardiovascular disease.”
Nygaard L, Polcwiartek C, Nelveg-Kristensen KE, et al; for the Danish Vasculitis Association investigators. Increased risk of cardiovascular disease preceding diagnosis of incident ANCA-associated vasculitis: a Danish nationwide study. Rheumatology (Oxford). Published online July 22, 2023. doi:10.1093/rheumatology/kead377