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Clin Exp Rheumatol. 2019 Sep 6. [Epub ahead of print]

Early development of new cardiovascular risk factors in the systemic vasculitides.

Author information

1
University of Pavia, Rheumatology Department, IRCCS Policlinico S. Matteo Fondazione, Pavia; University of Pavia, PhD in Experimental Medicine, Pavia, Italy; NDORMS, Rheumatology Department, Nuffield Orthopaedic Centre, University of Oxford, UK. sara.saramonti@gmail.com.
2
Faculty of Health and Applied Sciences, University of the West of England; School of Clinical Sciences at South Bristol, University of Bristol, UK.
3
Biometry and Clinical Epidemiology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy.
4
NDORMS, Rheumatology Department, Nuffield Orthopaedic Centre, University of Oxford, UK.
5
University of Pavia, Rheumatology Department, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy.
6
Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, Norfolk, UK.
7
Division of Rheumatology and Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

OBJECTIVES:

To analyse the frequency and predictors of new-onset cardiovascular (CV) risk factors in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and giant cell arteritis (GCA).

METHODS:

We analysed the frequency and predictors of new-onset hypertension and/or diabetes mellitus (HTN/DM) amongst patients with AAV or GCA recruited in the Diagnostic and Classification of Vasculitis (DCVAS) study. Patients with pre-existing HTN/DM were excluded.

RESULTS:

We included 873 patients with AAV (506 GPA, 183 MPA, 184 EGPA), and 443 with GCA. Patients with GCA were more likely female (68% vs. 52%; p<0.001) and older (71.33±8.65 vs. 52.80±16.48; p<0.001) compared to patients with AAV. HTN/DM developed within 6 months of diagnosis in 9% of patients with AAV (6% in GPA, 21% in MPA, 3% in EGPA) and 6% of patients with GCA, p=0.15. Rise in creatinine/reduced glomerular filtration rate and/or anaemia (OR 3.98, 95% CI 2.09-7.59, p<0.001) and diagnosis (MPA: OR 2.42, 95%CI 1.52-3.83, p<0.001 and GCA: OR 2.12, 95%CI 1.34-3.38, p=0.001 vs. GPA) were significantly associated with the occurrence of HTN/DM after adjusting for age, sex, ethnicity, and smoking status. We developed and validated a predictive score to discriminate patients according to the risk of developing HTN/DM within 6 months from diagnosis.

CONCLUSIONS:

Despite different epidemiological and clinical characteristics, new CV risk factors occur equally in the early stages of AAV and GCA. Renal function and type of diagnosis are associated with the occurrence of HTN/DM. We developed a simple predictive score for the risk-stratification of patients.

PMID:
31498071

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