Elevated stroke, myocardial infarction risks found for patients with ANCA-associated vasculitis

MADRID — ANCA-associated vasculitis demonstrated a significant association with stroke risk and a trend toward myocardial infarction, according to findings presented at the EULAR Annual Congress.

Gregory Pugnet, MD, of the Service de Medecine Interne, CHU Toulouse Purpan, in France, and colleagues aimed to investigate these risks and whether there was an associated increase in mortality. They compared outcomes in patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) to those reported in the general French population.

The study was a retrospective chart review of data from 1981 to 2015. ANCA-positive or histologically confirmed cases of vasculitis were included, while cardiovascular outcomes were measured by international guidelines. The investigators calculated incidence rates in person-years.

The final cohort included 99 patients with GPA and 26 patients with MPA. Baseline data showed the mean age of the cohort was 61 years. Half of the cohort were men. Moreover, 36% had underlying hypertension and 5% had a history of ischemic stroke.

Results indicated 10 acute myocardial infarctions occurred during follow-up, for an incidence rate 8.5 per 1,000 person-years.

“This was two-times more than the general population,” Pugnet said.

There were nine ischemic strokes reported for an incidence of 10.2 per 1,000 person-years.

“This was three-times higher than the general population,” Pugnet said.

The researchers observed 22 deaths, for a rate of 22.5 per 1,000 person-years and an increase of 1.5-times the general population, according to Pugnet.

Multivariable analysis results showed an independent association between vasculitis and first myocardial infarction (MI; hazard ratio [HR] = 8.8). Smoking demonstrated an association with coronary artery disease occurrence at occurrence of ANCA-associated vasculitis (adjusted HR = 8.8). A history of coronary artery disease also was associated with coronary artery disease at diagnosis of vasculitis (HR = 10.3). There was also an association between ANCA-associated vasculitis with central nervous system flare and stroke (HR = 3.9).

Conversely, ear-nose-throat flare showed a protective effect on coronary artery disease occurrence (HR = 0.12).

“Despite some limitations, we show in an ANCA-associated vasculitis cohort from southwest France, a significantly increased risk of stroke, with a trend toward increased risk of MI,” Pugnet said. “There was also a significantly increased risk of mortality. We think it is important to be vigilant to assess for cardiovascular risk factors in this population.” — by Rob Volansky

References:

Mourguet M, et al. Abstract #OP0321. Presented at: EULAR Annual Congress; June. 14-17, 2017. Madrid.

Disclosures: The researchers report no relevant financial disclosures.