Cardiovascular and Cerebrovascular Outcomes in Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis

Background:

Cardiovascular and cerebrovascular outcomes in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) remain elusive, especially for some specific cardiovascular and cerebrovascular disease (CCVD). We aimed to quantify the magnitude of the risk of total and type-specific CCVD in AAV population.

Method:

Electronic database searches of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed. Observational studies reporting data on CCVD in AAV patients were eligible. Pooled risk ratios (RR) with 95% confidence intervals were calculated. The primary outcome was the risk of CCVD, CAD and CVA in AAV population. The secondary outcomes were the risk of cause-specific CCVD, including myocardial infraction, angina pectoris, heart failure, stroke, ischemic stroke.

Results:

Fourteen studies met the inclusion criteria, comprising 20,096 AAV patients (over 46,495 person-years) with 5,757 CCVD events. Compared with non-vasculitis population, AAV patients showed an 83% increased risk of incident CCVD (1.83 [1.37-2.45]; n=10), 48% for coronary artery disease (1.48 [1.26-1.75]; n=9), and 56% for cerebrovascular accident (1.56 [1.22-1.99]; n=9). For type-specific CCVD, the risks of myocardial infarction, stroke, heart failure were increased by 67% (1.67 [1.29-2.15]; n=6), 97% (1.97 [1.19-3.25]; n=8) and 72% (1.72 [1.28-2.32]; n=4), whereas there was only a trend toward a higher risk of angina pectoris (1.46 [0.90-2.39]; n=2), and ischemic stroke (1.88 [0.86-4.12]; n=4). Subgroup analyses by AAV type found significantly increased CCVD risk in both granulomatosis with polyangiitis (1.87 [1.29-2.73]; n=7) and microscopic polyangiitis (2.93 [1.58-5.43]; n=3). In three studies reporting impact of follow-up period after AAV diagnosis, the CCVD risk was significantly higher in the first two years after diagnosis than the subsequent follow-up (2.23 [2.00-2.48] vs. 1.48 [1.40-1.56]; p < 0.01). Significant heterogeneity existed in the main analyses.

Conclusions:

This meta-analysis demonstrates that AAV is associated with increased risks of overall and type-specific CCVD, especially within two years after AAV diagnosis.