Risk Factors for Cardiovascular Events in Patients With ANCA-Associated Vasculitis Evaluated

Risk factors for cardiovascular events included both geographic region and traditional and disease-specific factors among patients with ANCA-associated vasculitis.

In patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), geographic region, along with disease-specific and traditional factors, are independently associated with cardiovascular (CV) events, according to study findings published in The Journal of Rheumatology.

The researchers sought to compare the incidence rates of myocardial infarction (MI) and stroke, as well as define the factors associated with a higher risk for CV events in a large cohort of individuals with AAV from various countries across the European Union, Turkey, China, Russia, UK, and US.

Patients with AAV were included in the study. Data regarding CV events, including fatal and nonfatal MI, stroke, or both, were collected retrospectively from tertiary vasculitis centers. Patients with a definite diagnosis of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA) who were followed up with for at least 3 months from diagnosis, and had sufficient data available on disease activity, comorbidities, and complications, were enrolled in the study.

Organ involvement was assessed using the Disease Extent Index, a simplified tool for evaluating extent of disease in retrospective studies at the time of diagnosis.

A total of 2286 patients (median age, 64.2 years; 53.4% women) were included in the study. Overall, 51.0% of the patients had MPA and 43.0% had GPA; 49.9% of the participants tested positive for myeloperoxidase (MPO)-ANCA and 38.6% tested positive for proteinase-3 (PR3)-ANCA. Kidney disease was reported in 73.3% of the patient cohort.

Proper assessment and management of modifiable cardiovascular risk factors are essential for prevention of cardiovascular morbidity in AAV patients.

Results of the study showed that over a median follow-up period of 62 months, CV events (mostly MI) were reported in 10.7% (n=245) of patients with AAV, with a higher frequency of CV events observed in China and the UK.

According to multivariate regression analysis, older age (55.0-64.9 years; hazard ratio [HR], 2.93; 95% CI, 1.99-4.31), smoking (HR, 1.98; 95% CI, 1.48-2.64), Chinese descent (HR, 4.24; 95% CI, 3.07-5.85), pulmonary involvement (HR, 1.50; 95% CI, 1.09-2.06), and kidney involvement (HR, 3.02; 95% CI, 2.08-4.37) were all independent variables associated with a higher occurrence for CV events.

A total of 445 patients died during follow-up; however, the causes of death were not detailed.

Study limitations included limited information on traditional and potential risk factors for CV events and data on certain clinical features of AAV; and the lack of country-based control groups that limited the potential to calculate risk ratios of CV events compared with a matched background population.

According to the study authors, “[D]epending on geographic region and duration of follow-up, up to 24% of [patients with] AAV develop MI or stroke within the first 5 years after diagnosis.” “Proper assessment and management of modifiable cardiovascular risk factors are essential for prevention of cardiovascular morbidity in patients [with AAV].”


Moiseev S, Bulanov N, Crnogorac M, et al. Traditional and disease specific risk factors for cardiovascular events in ANCA-associated vasculitis: a multinational retrospective study. J Rheumatol. Published online January 15, 2023. doi:10.3899/jrheum.220851