Patients with Wegener's granulomatosis: a long-term follow-up study.
BACKGROUND
Atherosclerosis is accelerated in Wegener's granulomatosis (WG) patients. This study was aimed to assess which factors can predict progression of atherosclerosis in WG.


METHODS
23 WG patients (14 men; age 47+/-9 years, mean+/-SD) and 21 controls (12 men; age 47+/-10 years) were included. Intima-media thickness (IMT) was determined by ultrasound, as measure for atherosclerosis. After median follow-up of 72 months (interquartile range: 66-76), IMT was repeated. Traditional risk factors for cardiovascular disease were determined, as well as levels of C-reactive protein (CRP) and endothelial activation markers, including thrombomodulin, vascular cell adhesion molecule-1 (VCAM-1) and von Willebrand factor (vWf). Disease-related factors were recorded from time of diagnosis until end of follow-up.


RESULTS
Maximum IMT at both evaluations was increased in patients. Patients had an increased prevalence of hypertension and increased levels of vWf and CRP. IMT progression was not different. IMT at follow-up was positively associated with age, blood pressure, CRP and VCAM-1, and negatively with HDL. During follow-up, disease activity was lower compared to the period from diagnosis until the first evaluation, and blood pressure and prevalence of dyslipidemia decreased in WG patients. Change in IMT was not correlated to any risk factor measured.


CONCLUSIONS
Maximum IMT was increased in WG patients. Progression of IMT was not different between patients and controls, probably because disease activity was low and reduction of traditional risk factors was achieved during follow-up. We suggest that control of disease activity and treatment of traditional risk factors are important to prevent cardiovascular disease in WG.
de Leeuw
Karina
K
Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, The Netherlands.
Bijzet
Johan
J
van der Graaf
Anne Marijn
AM
Stegeman
Coen A
CA
Smit
Andries J
AJ
Kallenberg
Cees G
CG
Bijl
Marc
M
D000328:Adult; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D014841:von Willebrand Factor / Q000378:metabolism
D015415:Biomarkers; D019010:Vascular Cell Adhesion Molecule-1; D014841:von Willebrand Factor; D002097:C-Reactive Protein