ANCA-Associated Vasculitis Patients Face Higher Risk of Stroke

Patients with antineutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitis (AAV) have an increased risk of coronary artery disease (CAD) and ischemic stroke, according to a recent study.

Modern treatments have improved survival rates in AAV patients. However, significant long-term morbidity and mortality are still associated with AAV.
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In their retrospective study, the researchers evaluated 125 patients diagnosed with AAV in

in Toulouse France teaching hospital from 1981 to 2015. Following thorough medical chart review, a total of 99 patients with granulomatosis with polyangiitis (GPA) and 26 with microscopic polyangiitis (MPA) were categorized in accordance with the criteria proposed by the Chapel Hill Consensus Conference. The study did not include patients with eosinophilic granulomatosis with polyangiitis.

A total of 65 (42%) patients were male. Mean age was 61.3 years, and mean follow-up was 88.4 months post-diagnosis.

The researchers analyzed rates of survival in their study. They also determined hazard ratios and the comparative morbidity and mortality figure, comparing the ratio of expected number of deaths in the standard population with those actually observed. Predictors of cardiovascular disease were also assessed.

Overall, 10 patients developed CAD and 9 had ischemic stroke. The researchers found that incidence of CAD among AAV patients is 2 times that of the general population, independent of age differences between each population, while incidence of ischemic stroke 3 times that of the general population. Furthermore, mortality among AAV patients was found to be 1.5 times that of the general population, independent of age differences.

Incidence of CAD among AAV patients was strongly associated with smoking and patient history of CAD. However, no statistically-significant associated factor was observed with incidence of ischemic stroke. Additionally, the researchers found ENT flares to be independent protective factor for incidence of CAD.

“Patients with AAV have a significantly increased risk of mortality and ischemic stroke and a non-statistically significant trend toward an increased risk of CAD,” the researchers concluded. “Monitoring for this complication and vigilance in modifying risk factors are particularly warranted in this patient population.”

—Christina Vogt

Reference:

Mourguet M, Chauveau D, Huart A, et al. Risk of coronary artery disease and ischemic stroke in patients with ANCA-associated vasculitis. A French population-based study. Ann Rheum Dis. 2017;76(2):188. doi:10.1136/annrheumdis-2017-eular.6143.