Cardiovascular Disease Risk Likely Increases After AAV Diagnosis

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by Steve Bryson PhD |

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People with ANCA-associated vasculitis (AAV) have a higher risk of cardiovascular disease, especially in the months immediately following AAV diagnosis, a population-based analysis found.

“Our study demonstrates a key ‘high-risk window’ that should prompt careful monitoring for CV [cardiovascular] disease and aggressive risk factor reduction,” the scientists said.

The study, “Association of ANCA-associated vasculitis and cardiovascular events: A population-based cohort study,” was published in the Clinical Kidney Journal.

AAV is a group of systemic inflammatory diseases characterized by damage to small blood vessels. This damage is most common in the kidneys and lungs, but also can lead to pain in the muscles and joints, as well as digestive problems.

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Studies suggest that diseases of the cardiovascular system — the heart, arteries, and veins — can be a major contributor to mortality in AAV patients.

However, a better understanding is needed of the distinct types of cardiovascular disease and the timing of their onset in people with AAV. This will help inform prevention strategies, develop new therapeutics, and support cardiovascular clinical trials that enroll AAV patients.

Researchers based at the University of Ottawa, in Canada, investigated the risks for specific types of cardiovascular disease and periods when there is an increased risk in AAV individuals.

“We hypothesized that patients with AAV would be at greater risk for CV events compared to those without AAV and the risk would be highest in the first year following diagnosis when AAV is most active,” the team wrote.

The team collected population-based data from the Institute for Clinical Evaluative Sciences (ICES) in the province of Ontario, Canada.

The primary outcomes were major adverse cardiovascular events — measured by a composite called MACE, which includes myocardial infarction (heart attack), stroke or temporary stroke symptoms (transient ischemic attack), and cardiovascular death.

Cardiovascular-associated atrial fibrillation (an irregular beat in the heart’s upper chambers) and heart failure were included as outcomes. Researchers also examined all-cause mortality and kidney failure.

The study included 1,520 people with AAV and 5,834 controls without AAV. Controls were matched to patients in a number of factors, such as age, sex, kidney function, income, and number of hospital stays in the prior three years.

The mean age was 61 years, 51% of patients were female, and their mean duration of follow-up was 1,387 days (almost four years).

A total of 60% of participants had a previous diagnosis of high blood pressure, and 34% had diabetes. The mean eGFR, a marker for kidney function, was 63 milliliters per minute (ml/min). Normal range is more than 90 ml/min.

The cumulative incidence for adverse cardiovascular outcomes in AAV was 15.4% for MACE, including 6.6% for myocardial infarction, 7% for stroke/transient ischemic attack, and 4.1% for cardiovascular death. Also, 16.4% of patients developed atrial fibrillation, and 20.8% had heart failure.

Compared with controls, AAV patients had a 49% significantly greater risk of stroke or transient ischemic attack, a 51% increased risk for atrial fibrillation, and a 41% greater risk of heart failure. In contrast, there was no increased risk for overall MACE, myocardial infarction, or death due to a cardiovascular event.

In the first year after diagnosis, however, patients had a 31% increased risk of MACE, a 52% greater risk of myocardial infarction, and an 87% increased risk of stroke or transient ischemic attack. They also had more than twice (2.06) the risk of atrial fibrillation than controls, and almost twice (1.75) the risk of congestive heart failure, but not for cardiovascular death.

The risk of adverse cardiovascular events was elevated mostly in the first 90 days after AAV diagnosis, especially for heart failure and atrial fibrillation.

AAV was associated with lower all-cause mortality over the entire follow-up period in the first year, and 90 days AAV diagnosis. The risk of kidney failure, however, was not significantly different between AAV patients and controls at any follow-up time.

Finally, using a more stringent AAV diagnosis definition, which included a positive test for disease-related antibodies, AAV patients still had similarly higher rates of adverse cardiovascular events in the period after diagnosis, as was seen in the full analysis.

After excluding events observed during hospitalization for AAV diagnosis, the overall risks were lower, but remained high for atrial fibrillation and heart failure.

“In conclusion, individuals with incident AAV are at high risk for adverse CV events, in particular [atrial fibrillation] and [heart failure],” the researchers wrote. “These risks are highest in the immediate 3 months and 1 year following diagnosis.”

The researchers added, “Future prospective studies targeting the prevention of CV events in AAV may be warranted.”