title: Management of cardiovascular risk factors in patients with ANCA-associated vasculitis.
abstract: OBJECTIVE
  Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is accompanied by increased cardiovascular (CV) risk. Treatment of AAV patients includes the management of conventional CV risk factors, primarily hypertension and hypercholesterolemia, while lipoprotein(a) (LP(a)) is an emerging potential target.
  
  
  METHODS
  We performed a multicenter, retrospective study in Germany. Patients were considered if they were between 18 and 90 years old and presented with AAV. Patients with arterial hypertension but no autoimmune disease were used as a control group (HTN reference group).
  
  
  RESULTS
  Compared to the reference group (n = 52), CV disease burden was significantly greater in patients with AAV (n = 53). Hypercholesterolemia was also more common in the AAV patients (71.7% vs 46.2% for the HTN; P = .008). Lipoprotein(a) levels were elevated in both groups, with 11.3% and 17.3% of the AAV and HTN groups, respectively, displaying a level above 0.6 g/l (P = .083). Guideline-recommended targets for low-density lipoprotein cholesterol and blood pressure levels were rarely met. According to Kidney Disease: Improving Global Outcomes guidelines, 72.5% of the patients with AAV should have been taking statins and/or ezetimibe for treatment of hyperlipidemia; however, only 24.3% of them were receiving such treatment. Blood pressure below ≤140/90 mmHg was reached in 78.6% of the patients with chronic kidney disease. However, for patients with chronic kidney disease and an albumin excretion rate of >30 mg/day, the recommended blood pressure is ≤130/80 mmHg, a value that was not reached in 65% of the AAV patients.
  
  
  CONCLUSIONS
  Patients with AAV are at high CV risk, but management of the associated risk factors is poor. In addition to improving the treatment of hypercholesterolemia and hypertension, lipoprotein(a) is a further potential target for reducing CV risk in individuals with AAV.
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.|Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
authors.forename: Carsten Paul
authors.identifier: http://orcid.org/0000-0003-4733-9282
authors.initials: CP
authors.lastname: Bramlage
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Kröplin
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Wallbach
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.|Institute for Research and Medicine Advancement (IRM), Terrassa, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Minguet
authors.affiliation: Institute for Research and Medicine Advancement (IRM), Terrassa, Spain.
authors.forename: Katherine Helen
authors.initials: KH
authors.lastname: Smith
authors.affiliation: Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Lüders
authors.affiliation: Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schrader
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Susan
authors.initials: S
authors.lastname: Patschan
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gross
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Deutsch
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Gerhard Anton
authors.initials: GA
authors.lastname: Müller
authors.affiliation: Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Koziolek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000453:epidemiology*; D001794:Blood Pressure; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007249:Inflammation / Q000453:epidemiology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
keywords: cardiovascular risk; hypercholesterolemia; hypertension; lipids; lipoprotein(a); vasculitis