Cardiovascular Risk Factors Found With Cases of AAV, Lupus Nephritis
Risk factors for cardiovascular diseases — those related to the heart and blood vessels — are common in people with ANCA-associated vasculitis and lupus nephritis, an autoimmune disease that causes inflammation in the kidneys, according to a study in Singapore.
The study, “Cardiovascular risk assessment in lupus nephritis and ANCA-associated vasculitis in real-world nephrology practice,” was published as a letter in the Clinical Kidney Journal.
Studies have shown the risk of stroke and cardiovascular events is 49–65% higher in people with ANCA-associated vasculitis, an autoimmune disease that causes damage to small blood vessels, including those in the kidneys. In patients with lupus nephritis and ANCA-associated vasculitis, the risk of hospitalization or death from cardiovascular-related events is also increased.
The European League Against Rheumatism (EULAR) multidisciplinary task force recently published recommendations for cardiovascular risk management in a number of diseases, including ANCA-associated vasculitis and lupus nephritis.
The recommendations highlight the need for doctors to screen for cardiovascular risk factors within six months of a diagnosis. This is in line with findings from a previous study showing that patients with ANCA-associated vasculitis have a higher risk of cardiovascular disease, especially in the months following a diagnosis.
A team of researchers from Singapore General Hospital set out to find how many patients with lupus nephritis and ANCA-associated vasculitis who went to the hospital for routine kidney testing had risk factors for cardiovascular disease.
They looked at data from 146 patients with lupus nephritis and ANCA-associated vasculitis. The patients were a median age of 42.6 at diagnosis and 114 (78.1%) were women.
High blood pressure (hypertension) is a major risk factor for cardiovascular disease, and it was present in 77 (52.7%) of the patients. Higher than normal levels of fatty molecules in the blood (hyperlipidemia), another major risk factor for cardiovascular disease, were present in 26 (17.8%) of patients.
Kidney disease was present in 42.5%, as determined by a glomerular filtration rate of less than 60 mL/min/1.73 m2. The glomerular filtration rate measures how well kidneys filter waste products out of the blood through urine.
Diabetes makes blood sugar (glucose) rise to abnormally high levels (hyperglycemia), and this can cause damage to kidney blood vessels. Of the 146 patients, 12 (8.2%) had diabetes.
Most (96.6%) were being treated with moderate to high doses of prednisolone, a glucocorticoid that works by reducing inflammation and suppressing the immune system.
Inducing disease remission, or preventing symptoms from manifesting for a period of time, is important to reduce cardiovascular risk in patients with ANCA-associated vasculitis and lupus nephritis.
“However, remission induction therapy with immunosuppressants such as steroids can exacerbate [cardiovascular] risks such as hyperglycemia, hypertension, obesity and hyperlipidemia,” the researchers wrote, adding that the treatment goal is to use the lowest possible dose of glucocorticoids to achieve disease control.
Many patients (87.0%) were on renin-angiotensin inhibitors, a type of medication to lower blood pressure, and 51.4% were taking medications such as statins to reduce the levels of fatty molecules in the bloodstream.
Over more than three years (37.9 months) of follow-up, 10 (6.8%) patients were admitted to the hospital due to a cardiovascular event at a median of 8.1 months after diagnosis. The reasons for hospital admission included heart attack, heart failure, or a buildup of cholesterol-containing deposits in the inner walls of heart arteries, making them narrower.
“More can be done to screen and optimize [cardiovascular] risk in patients with lupus nephritis and vasculitis during routine nephrology practice,” the researchers wrote.