Birmingham Score Predicts Risk for Heart Disease-related Deaths in AAV Patients, According to Study

Increases in the Birmingham Vasculitis Activity Score (BVAS) may work as an independent risk predictor for cardiovascular  disease (CVD)-related deaths in ANCA-associated vasculitis, a single-center study from China found.

The study, “The BVAS is an independent predictor of cardiovascular events and cardiovascular disease-related mortality in patients with ANCA-associated vasculitis: A study of 504 cases in a single Chinese center,” was published in the journal Seminars in Arthritis and Rheumatism.

The European Vasculitis Society (EUVAS) found that the major cause of death among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is heart disease. Now, authors investigated the risk factors for cardiovascular events and CVD-related mortality in a Chinese group of AAV patients.

The study included 504 patients with newly diagnosed AAV, all following the Chapel Hill Consensus Conference criteria for AAV. The team looked for factors, including age, sex, body mass index, diabetes, hypertension, and various lab parameters that could predict the risk for cardiovascular events (CVEs) and cardiovascular disease-related mortality.

Thanks to corticosteroids and cyclophosphamide, more than 70 percent of AAV patients survive for five or more years. But these patients still have higher mortality rates than the general population.

“In our study, total CVD-related mortality was 1,834 per 100,000 person-years, which is much higher than the CVD-related mortality in the general adult population in China,” previously reported at 707 per 100,000 person-years.

In their analysis, the authors observed that the majority of cardiovascular events (CVEs) and heart disease-related deaths occurred more than a year after patients were diagnosed with AAV, a period when the disease is already in remission. In fact, “almost half of the CVEs and CVD-related mortality occurred after two years since diagnosis,” the researchers wrote.

They identified the traditional independent predictors of CVEs, which included age, systolic blood pressure, estimated glomerular filtration rate (eGFR), and high-density lipoprotein. Predictors of risk for CVD-related mortality were age, eGFR, and pre-existing heart disease.

The authors also found that the Birmingham Vasculitis Activity Score (BVAS) is a new independent predictor for both CVEs and CVD-related mortality in AAV patients.

“The most important finding in our study was that, besides traditional risk factors, BVAS at presentation was an independent predictor of new CVE and CVD-related mortality,” the researchers wrote.

“More importantly, considering the gradual development of CVD, we further analyzed the CVEs and CVD-related mortality after two years since diagnosis, and found that BVAS at presentation was still an independent predictor of CVEs and CVD-related mortality,” they concluded.