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Abstract: FR-PO1047

Risk of Ischemic Heart Disease Is Increased in Patients with ANCA-Associated Vasculitis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Rahmattulla, Chinar, Leiden University Medical Center, Leiden, Netherlands
  • Kronbichler, Andreas, Medical University Innsbruck, Innsbruck, Austria
  • Wolterbeek, Ron, Leiden University Medical Center, Leiden, Netherlands
  • Bruijn, Jan A., Leiden University Medical Center, Leiden, Netherlands
  • Bajema, Ingeborg M., Leiden University Medical Center, Leiden, Netherlands
  • Jayne, David R.W., University of Cambridge, Cambridge, United Kingdom
Background

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a chronic autoimmune disease characterized by inflammation of the small to medium-sized blood vessels. A well-established long-term complication of many inflammatory diseases is the occurrence of cardiovascular events. In AAV, the results of experimental studies indicate the occurrence of accelerated atherosclerosis. However, the risk of ischemic heart disease (IHD) in patients with AAV remains poorly quantified. The aim of this study is to investigate the IHD risk in patients with AAV and to examine the effect of immunosuppressive therapy on the IHD risk.

Methods

The study included patients with AAV treated at the Vasculitis and Lupus Clinic in Addenbrooke's Hospital (Cambridge, United Kingdom) between 1990 and 2015. The occurrence of IHD (defined as angina pectoris or myocardial infarction) in these patients was compared with the incidence in the general population by calculating standardized incidence ratios (SIRs), adjusted for sex, age, and calendar year.

Results

Of the 529 included patients, 51 patients developed a total of 57 ischemic heart events during a mean follow-up of 6.3 years. This represented a 2.0-fold increased (95%CI 1.53-2.58, p<0.001) IHD risk in AAV patients compared to the sex-, age-, and calendar year matched general population. There was no significant difference in follow-up duration of patients with and without IHD (mean follow-up of 6.3 year and 5.4 year, respectively) IHD risk was higher in patients with MPO-ANCA (SIR 2.31; 95%CI 1.55-3.44; P <0.001) than in patients with PR3-ANCA (SIR 1.63; 95%CI 1.01-2.61; p=0.043). Moreover, IHD was increased in patients treated with cyclophosphamide (SIR 1.78; 95%1.22-2.60; p=0.003), but not in patients treated with rituximab (SIR 1.03; 95%CI 0.26-4.10; p=0.971).

Conclusion

The result of this large study demonstrate that patients with AAV have an increased IHD risk as compared to the sex-, age-, and calendar year matched general population. IHD risk was higher in patients with MPO-ANCA. Importantly, IHD risk was not increased in patients treated with rituximab but was increased in patients treated with cyclophosphamide. The results of this study demonstrate a need for the active monitoring and treatment of cardiovascular risk factors in patients with AAV.