M Mourguet1, D Chauveau2, S Faguer2, J B Ruidavets3, Y Béjot4, D Ribes2, A Huart2, L Alric5, L Balardy6, L Astudillo7, D Adoue8, L Sailler7, G Pugnet7. 1. Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne, CHU Toulouse Purpan, Toulouse, France. Electronic address: mourguet.m@chu-toulouse.fr. 2. Université de Toulouse Paul Sabatier, Toulouse, France; Département de néphrologie et transplantation d'organe, CHU Toulouse Rangueil, Toulouse, France. 3. Laboratoire d'épidémiologie et santé communautaire - Unité INSERM UMR 1027, CHU Toulouse Purpan, Toulouse, France. 4. Département de Neurologie, CHU Dijon Hôpital Le Bocage, Dijon, France; Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, France. 5. Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne - Fédération digestive, CHU Toulouse Purpan, Toulouse, France. 6. Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne et Oncologie Gériatrique, CHU Toulouse Purpan, Toulouse, France. 7. Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne, CHU Toulouse Purpan, Toulouse, France. 8. Université de Toulouse Paul Sabatier, Toulouse, France; Service de Médecine Interne et Immunopathologie clinique, Institut Universitaire du Cancer Oncopôle CHU Toulouse, Toulouse, France.
Abstract
OBJECTIVE: The aim of our study was to assess major cardiovascular event incidence, predictors, and mortality in ANCA-associated vasculitis (AAV). METHODS: We conducted a retrospective cohort study of all GPA or MPA, according to Chapel Hill Consensus Conference classification criteria, diagnosed between 1981 and 2015. Major cardiovascular event was defined as acute coronary artery disease, or ischemic stroke, or peripheral vascular disease requiring a revascularization procedure. We calculated the comparative morbidity/mortality figure (CMF) and we used Cox proportional hazards regression models to assess the risk of coronary artery disease, ischemic stroke associated with AAV, after adjusting for covariates. RESULTS: 125 patients, 99 GPA (79,2%) and 26 MPA (20,8%), were followed 88.4 ± 78.3 months. Ischemic stroke incidence was four times higher than in the general population (CMF 4,65; 95% CI 4,06-5,31). Coronary artery disease incidence was four times higher than in the general population (CMF 4,22; 95% CI 1,52-11,68). Smoking habits and history of coronary artery disease were strongly associated with coronary artery disease occurrence (adjusted HR 8.8; 95% CI 2.12-36.56, and adjusted HR 10.3; 95% CI 1.02-104.5, respectively). ENT flare-up was an independent protective factor for coronary artery disease occurrence. We did not identify factors significantly associated with stroke occurrence. The age-adjusted mortality rate was 22.5 per 1000 person-years. Mortality in AAV was 1.5 times higher than in the general population (CMF 1.56; 95% CI 1.34-1.83). CONCLUSION: AAV have a significantly increased risk of mortality, ischemic stroke, and coronary artery disease.
OBJECTIVE: The aim of our study was to assess major cardiovascular event incidence, predictors, and mortality in ANCA-associated vasculitis (AAV). METHODS: We conducted a retrospective cohort study of all GPA or MPA, according to Chapel Hill Consensus Conference classification criteria, diagnosed between 1981 and 2015. Major cardiovascular event was defined as acute coronary artery disease, or ischemic stroke, or peripheral vascular disease requiring a revascularization procedure. We calculated the comparative morbidity/mortality figure (CMF) and we used Cox proportional hazards regression models to assess the risk of coronary artery disease, ischemic stroke associated with AAV, after adjusting for covariates. RESULTS: 125 patients, 99 GPA (79,2%) and 26 MPA (20,8%), were followed 88.4 ± 78.3 months. Ischemic stroke incidence was four times higher than in the general population (CMF 4,65; 95% CI 4,06-5,31). Coronary artery disease incidence was four times higher than in the general population (CMF 4,22; 95% CI 1,52-11,68). Smoking habits and history of coronary artery disease were strongly associated with coronary artery disease occurrence (adjusted HR 8.8; 95% CI 2.12-36.56, and adjusted HR 10.3; 95% CI 1.02-104.5, respectively). ENT flare-up was an independent protective factor for coronary artery disease occurrence. We did not identify factors significantly associated with stroke occurrence. The age-adjusted mortality rate was 22.5 per 1000 person-years. Mortality in AAV was 1.5 times higher than in the general population (CMF 1.56; 95% CI 1.34-1.83). CONCLUSION: AAV have a significantly increased risk of mortality, ischemic stroke, and coronary artery disease.