Artikel
Risk of cardiac and vascular morbidity in ANCA-associated vasculitis (AAV): A large-scale propensity-matched global retrospective cohort study
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Autoren
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Sebastian Klapa
- University of Lübeck, Rheumatology and Clinical Immunology, Lübeck; Christian-Albrechts-University Kiel, Institute of Experimental Medizin, German Naval Medical Institute, Kronshagen
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Henry Nording
- University of Lübeck, Cardioimmunology research group, Lübeck
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Marlene Ludwig
- Independent Researcher, Groß Grönau
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Andreas Koch
- Christian-Albrechts-University Kiel, Institute of Experimental Medizin, German Naval Medical Institute, Kronshagen
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Sabrina Arnold
- University of Lübeck, Rheumatology and Clinical Immunology, Lübeck
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Antje Müller
- University of Lübeck, Rheumatology and Clinical Immunology, Lübeck
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Khalaf Kridin
- Bar-Ilan University, Azrieli Faculty of Medicine, Safed; Galilee Medical Center, Unit od Dermatology and Skin Research Laboratory, Nahariya
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Anja Staehle
- University of Lübeck, Rheumatology and Clinical Immunology, Lübeck
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Ralf Ludwig
- University of Lübeck, Lübeck Institute of Experimental Dermatology, Lübeck
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Peter Lamprecht
- University of Lübeck, Rheumatology and Clinical Immunology, Lübeck
| Veröffentlicht: | 18. September 2024 |
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Gliederung
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Introduction: Following diagnosis, the main causes of death in ANCA-associated vasculitis (AAV) are active vasculitis and infections during the first year and cardiovascular disease, malignancies and infections during subsequent years. Population-based database and cohort analyses suggest an increased risk for major adverse cardiovascular events (MACE) in AAV.
This study aimed to determine the risk of death and cardiovascular outcomes in AAV using a large global electronic health record database for biomedical and clinic research (TriNetX).
Methods: Data samples from an electronic health records database of the US-based TriNetX network were analysed. Patients (aged ≥18 years) with the diagnostic codes of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) and patients without vasculitis as matched control cohort (1:1) were included. Propensity score matching for demographic variables and cardiovascular and metabolic comorbidities was performed to optimize between-group comparability. Hazard ratios (HR) were calculated by univariate Cox regression after analysis of the matched cohort by the Kaplan-Meier method.
Results: In total, 27,097 AAV patients were included (GPA, n=21,190; MPA, n=5,907). The unadjusted and adjusted relative risk (RR) of mortality was increased in GPA (RR 17.87%) and MPA (RR 25.85%) compared to matched controls (GPA: HR:3.010 P<0.0001, MPA: HR:3.007, P<0.0001). The risks of all screened cardiovascular events were increased in GPA and MPA compared to matched controls (P<0.0001) and did not differ when adjusted according to gender, disease duration and age. Especially the risk for thromboembolic events was increased compared to matched controls (deep vein thrombosis: GPA HR:2.819, MPA HR:3.334; pulmonary embolism: GPA HR:3.009, MPA HR:2.997). MPA patients had a higher risk for MACE compared to GPA (MPA vs. GPA: 24.38% vs. 23.76%, HR:1.160 P=0.0023) and peripheral arterial disease (MPA vs. GPA:21.38% vs. 21.17%, HR:1.165 P=0.0018).
Conclusion: In AAV, the risks of death and cardiovascular events were increased. Compared to GPA, MPA was associated with an increased risk for MACE and peripheral arterial disease.
