title: Increased incidence of cardiovascular events in patients with antineutrophil cytoplasmic antibody-associated vasculitides: a matched-pair cohort study.
abstract: OBJECTIVE
  To explore the risk of cardiovascular disease in patients with antineutrophil cytoplasmic antibody-associated vasculitides (AAVs) and to assess contributing risk factors.
  
  
  METHODS
  In a retrospective matched-pair cohort study, 113 of 131 patients with AAVs from a vasculitis clinic registry were matched 1:1 for renal function, age at diagnosis, sex, smoking status, and previous history of a cardiovascular disease to patients with noninflammatory chronic kidney disease (CKD). Cardiovascular events were defined as acute coronary syndrome, new-onset angina, symptomatic peripheral vascular disease, stroke, and transient ischemic attack.
  
  
  RESULTS
  Median followup times were 3.4 years for the AAV patients and 4.2 years for the CKD patients. More cardiovascular events occurred in the AAV group (23 of 113) than in the CKD group (16 of 113). Cox regression survival analysis showed a significantly increased risk of a cardiovascular event for AAV patients, with a hazard ratio (HR) of 2.23 (95% confidence interval [95% CI] 1.1-4.4) (P = 0.017). Within the cohort of AAV patients, the most strongly predictive factors were previous history of cardiovascular disease (HR 4 [95% CI 1.7-9.8]), history of dialysis dependency (HR 4.3 [95% CI 1.5-12.1]), ever having smoked (HR 3.9 [95% CI 1.5-10]), age at diagnosis (HR 1.038 [95% CI 1.006-1.072]), estimated glomerular filtration rate at remission (HR 0.977 [95% CI 0.957-0.998]), and serum cholesterol concentration at presentation (HR 0.637 [95% CI 0.441-0.92]).
  
  
  CONCLUSIONS
  In this retrospective study, patients with AAVs appear at greater risk of cardiovascular disease, with increased risk in those with a previous history of cardiovascular disease, dialysis dependency, poor renal function at remission, or a history of smoking. Measures to reduce the risk of cardiovascular disease should be integral to the management of systemic vasculitis.
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Morgan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Turnbull
authors.forename: Umut
authors.initials: U
authors.lastname: Selamet
authors.forename: Manvir
authors.initials: M
authors.lastname: Kaur-Hayer
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ferro
authors.forename: Caroline O S
authors.initials: CO
authors.lastname: Savage
authors.forename: Lorraine
authors.initials: L
authors.lastname: Harper
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology*; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors