title: Factors associated with major cardiovascular events in patients with systemic necrotizing vasculitides: results of a longterm followup study.
abstract: OBJECTIVE
  Systemic necrotizing vasculitides (SNV) are associated with more frequent subclinical atherosclerosis, suggesting that SNV might be associated with a higher risk of major cardiovascular events (MCVE). We aimed to identify factors predictive of MCVE in patients with SNV.
  
  
  METHODS
  Patients in remission from SNV were assessed for CV risk factors and subclinical atherosclerosis. MCVE was defined as myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, and/or death from CV causes. MCVE-free survival curves were compared using the log-rank test.
  
  
  RESULTS
  Forty-two patients were followed for 7.1±2.6 years. Eight patients (18.9%) had MCVE. The respective 5- and 10-year MCVE rates were 9.5% and 26.8%. National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III)-defined high-risk status [hazard ratio (HR) 5.02 (95% CI: 1.17-27.4), p=0.03], BMI>30 kg/m2 [HR 4.84 (95% CI: 1.46-116), p=0.02], and plaque detection in the abdominal aorta (p=0.01) were significantly associated with MCVE. SNV characteristics, corticosteroid maintenance therapy, and C-reactive protein>5 mg/l were not associated with MCVE. Plaque in the aorta was significantly associated with high-risk status (p<0.001), while BMI and high-risk status were independent variables. Thus, a BMI>30 kg/m2 and/or a high-risk status were strongly associated with MCVE (p=0.004). Carotid intima-media thickness (IMT) identified patients with early MCVE and was correlated with the time to MCVE (r2=0.68, p=0.01).
  
  
  CONCLUSIONS
  These results suggest that factors associated with a higher MCVE risk in patients with SNV are NCEP/ATP III-defined high-risk status and BMI>30 kg/m2. Carotid IMT could help identify patients with SNV at risk of early MCVE.
authors.affiliation: From the Department of Internal Medicine, Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris-Descartes; Centre de Médecine Préventive Cardiovasculaire, Hôpital Européen Georges-Pompidou, Inserm U970, Université Paris-Descartes, Paris, France; and Mount Sinai Hospital, University of Toronto, Division of Rheumatology, Department of Medicine, Toronto, Ontario, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Terrier
authors.forename: Gilles
authors.initials: G
authors.lastname: Chironi
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.forename: Pascal
authors.initials: P
authors.lastname: Cohen
authors.forename: Xavier
authors.initials: X
authors.lastname: Puéchal
authors.forename: Alain
authors.initials: A
authors.lastname: Simon
authors.forename: Luc
authors.initials: L
authors.lastname: Mouthon
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D010488:Polyarteritis Nodosa / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D018608:Ultrasonography, Doppler / Q000379:methods
keywords: ACCELERATED ATHEROSCLEROSIS; CARDIOVASCULAR EVENTS; NECROTIZING VASCULITIDES