High Blood Pressure and Other Cardiovascular Risks Prevalent in ANCA Vasculitis Patients, Researchers Say

High blood pressure and other cardiovascular risk factors are highly prevalent in people with ANCA-associated vasculitis (AAV), and a sizable number — more than one-third — of patients are not properly treated, researchers report.

The work, “Prevalence and management of cardiovascular risk factors in ANCA-associated vasculitis,” appeared as a “letter to the editor” in the journal Rheumatology.

Previous studies reported that AAV patients are at greater risk of accelerated atherosclerosis — narrowing of blood vessels — and a cardiovascular risk of nearly 65%.

Better understanding of the prevalence of cardiovascular risk factors — including markers of inflammation and chronic kidney disease — as well as of their optimal management may improve long-term outcomes for these people.

A team from The Netherlands and Canada addressed risk factors in AAV, while also assessing how well both countries adhered to current cardiovascular risk management guidelines.

A total of 144 adults were included (56% men, 81% Caucasian), 71 recruited at the Northwest Clinics in The Netherlands from October 2016 to May 2017, and 73 at the Mount Sinai Hospital Vasculitis Clinic, in Toronto, from July to October 2018. Patients’ mean age was 62.

The scientists analyzed their history of cardiovascular disease, and conducted a physical examination, blood pressure measures, and laboratory tests.

The most common AAV subtype was granulomatosis with polyangiitis (69%), followed by microscopic polyangiitis (17%), and eosinophilic granulomatosis with polyangiitis (14%). Most patients were in clinical remission, as assessed by the Birmingham Vasculitis Activity Score.

Across all patients, the mean estimated 10-year risk of cardiovascular disease — as assessed via the Framingham score — was 19%, which may be a substantial underestimation, the team said. In the Dutch group, the mean 10-year Systematic Coronary Risk Evaluation (SCORE) risk of cardiovascular disease was 24%.

High blood pressure was found in 72% of patients, and dyslipidemia (abnormal lipid — cholesterol and triglyceride — levels) in 69%. Data also showed 43% had chronic kidney disease, 20% had history of a cardiovascular event, 11% had diabetes mellitus, 3% were current smokers, and 51% were former smokers.

Most patients were being treated with anti-hypertensives, and 33% with lipid lowering therapies, most often statins. In contrast, 36% of patients had an indication for blood pressure-lowering medicines and 25% a recommendation to use lipid-lowering treatments, but these people were either untreated or not on target levels as defined in national guidelines.

“Patients with AAV have a high prevalence of traditional CV [cardiovascular] risk factors and our data show that management of these risk factors could be improved in this high-risk population,” the investigators wrote. “Long-term follow-up studies are needed to identify the contribution of individual CV risk factors.”