Cardiovascular Disease Precedes ANCA-associated Vasculitis Save

A nested case–control study from the Danish Nationwide Registries finds an increased risk of cardiovascular (CV) disease in the months preceding diagnosis of ANCA-associated vasculitis (AAV).

Patients with granulomatosis with polyangiitis and microscopic polyangiitis were identified through the Danish Nationwide Registries (1996 to 2021) and matched 1:3 with age- and sex-matched controls without AAV. They identified major adverse cardiovascular events (MACE), ischaemic heart disease, coronary angiogram, heart failure, venous thromboembolism, atrial fibrillation, ischaemic stroke, pericarditis and ventricular arrhythmias/implantable cardioverter defibrillator implantation/cardiac arrest (VA/ICD/CA) within 12 months, 6 months, 3 months, 2 months and 1 month before the diagnosis date.

A total of 2371 AAV patients (median age 63 years, 53.7% male) were compared with 7113 controls.

In the 12 months prior to the index date a higher prevalence of CV outcomes (10.3%) and MACE (2.4%) was seen in AAV, compared with to controls (3.8%, and 1.3%, respectively. Thus a 3 fold (HR 3.05) and 2 fold (HR 1.98) higher rate was of CV disease was evident 12 mos. prior to diagnosis. 

The highest risk of CV outcomes was seen at 1 month prior to index date (HR 10.73 CV and HR 5.78 MACE).

The risk of CV disease should be promptly assessed and considered with each new diagnosis of AAV disease.