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22-09-2017 | Rheumatology | News | Article

Active CV risk management needed in ANCA-associated vasculitis

medwireNews: A meta-analysis has highlighted the cardiovascular (CV) risk faced by patients with vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCAs).

Dutch researchers report that patients with ANCA-associated vasculitis had a 65% increased risk for CV events relative to the general population, similar to that observed in the setting of other chronic inflammatory diseases.

Most of this excess risk could be attributed to an increased risk for ischemic heart disease, with only a trend for an increased risk for cerebrovascular accidents, and very limited data on peripheral arterial disease.

Reporting in Rheumatology, Tiny Hoekstra (VU University Medical Centre, Amsterdam) and colleagues maintain: “There is a clear need for active cardiovascular risk management in patients with ANCA-associated vasculitis.”

ANCA-associated vasculitis is a chronic inflammatory disease of the blood vessel wall that can be subclassified into granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis, the investigators explain.

Although premature atherosclerosis and CV events are a well-established long-term complication of many inflammatory diseases, they note that the increased risk in ANCA-associated vasculitis is poorly quantified.

To investigate further, the team conducted a meta-analysis of seven observational studies, including nearly 14,000 patients with ANCA-associated vasculitis who were compared with the general population in six studies and patients with chronic kidney disease in one study.

ANCA-associated vasculitis carried a relative risk of 1.65 for all CV events, with a relative risk of 1.60 for ischemic heart disease. The condition was also associated with a relative risk of 1.20 for cerebrovascular accidents, but the confidence intervals crossed 1.

The meta-analysis did not include studies that addressed the risk of peripheral arterial disease separately.

The researchers suggest several pathophysiological mechanisms could account for the increased risk for CV events identified, such as active vasculitis, atherosclerosis, a hypercoagulable state, or hemorrhage.

They say their results underline recent guidelines from EULAR, which recommend active monitoring and treatment of traditional CV risk factors as part of the standard care for patients with ANCA-associated vasculitis.

“This will include cessation of smoking, control of weight and encouragement to engage in physical activity,” say Hoekstra et al. “Furthermore, traditional treatment of cardiovascular risk factors, such as hypertension and hypercholesterolaemia, should actively be performed.”

By Anita Chakraverty

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