AAV raises the risk of cardiovascular disease, review study finds
Higher incidence of stroke, blood clots in veins and other conditions seen
People with ANCA-associated vasculitis (AAV) have a higher risk of cardiovascular diseases and related mortality than people without the disease, according to a systematic review and meta-analysis of published studies.
For example, the risk of venous thromboembolism, a blood clot that develops in a vein, was three times higher in patients, and the risk of stroke was about 43% higher.
“Routine cardiovascular evaluations and tailored treatment regimens can help mitigate these risks,” and may “lead to substantial improvements in long-term outcomes and quality of life for AAV patients,” the researchers wrote.
The study, “Assessment of cardiovascular risk in patients with ANCA-associated vasculitis: A systematic review and meta-analysis,” was published in the International Journal of Cardiology Cardiovascular Risk and Prevention.
Cardiovascular disease known to rise with chronic inflammatory disorders
AAV is characterized by inflammation and damage to small blood vessels, with the disease caused by self-reactive antibodies, called ANCAs, that bind to neutrophils, a type of immune cell. This binding excessively activates neutrophils, and ultimately promotes inflammation and damage to cells lining blood vessels.
Disease symptoms may affect multiple organs, depending on where the vascular damage occurs, with the lungs and kidneys being the most common. But the cardiovascular system can also be affected, and “cardiovascular complications … represent a significant source of morbidity and mortality in patients with AAV,” the researchers wrote.
“Although chronic inflammatory diseases are linked to an increased risk for cardiovascular diseases, the specific extent of this risk in [AAV] remains elusive, largely due to the disease’s rarity,” they added.
An international team of researchers systematically reviewed studies published up to April reporting cardiovascular risk and mortality in people with and without AAV.
A total of nine observational studies, conducted in North America, Europe, and Asia, and published between 2009 and 2023, were included in the meta-analysis. These studies covered a total of 45,024 individuals: 5,643 with AAV and 39,341 without the disease, used as controls.
Stroke risk 43% higher with AAV, blood clots in veins two times higher
A main goal was to assess whether the risk of stroke differed between the two groups. Pooled results from seven studies showed that the overall risk for stroke was significantly higher, by about 43%, in AAV patients relative to controls.
“This increased risk can be attributed to the inflammatory burden associated with vasculitis,” the researchers wrote.
The risk for other cardiovascular diseases was also significantly higher in the AAV group. The risk of ischemic heart disease — when the heart muscle does not get enough blood and oxygen due to the narrowing of coronary arteries — was 40% higher, and that of a heart attack was 49% higher, with each analysis based on reports of four studies.
Pooled data from five studies demonstrated that AAV patients had a twice higher risk of venous thromboembolism, and data from three studies showed a four times higher risk of deep vein thrombosis, when a blood clot forms in a deep vein, commonly in the leg.
Need for proactive risk management, especially in early disease stages
The risk of pulmonary embolism, when the blood clot breaks loose from a vein and travels to the lungs, was about three times higher in AAV patients than in controls, based on pooled data from four studies.
People with AAV also had a 63% higher risk of heart failure, and a 79% higher risk of death due to cardiovascular events compared with those without the disease, based on two studies for each outcome.
“This meta-analysis underscores the significant association between AAV and heightened cardiovascular morbidity including stroke, ischemic heart disease, [heart attack], venous thromboembolism, pulmonary embolism, deep vein thrombosis, and heart failure,” the team wrote.
Findings also emphasize “the need for a refined approach to managing AAV due to its significant cardiovascular risks,” the researchers concluded. “Future management strategies should focus on proactive cardiovascular risk assessment and monitoring, especially in the early stages of AAV.”
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