Association of anti-neutrophil cytoplasmic antibody-associated vasculitis and cardiovascular events: a population-based cohort study

Background — ANCA-associated vasculitis (AAV) is implicated in elevating the risk for cardiovascular (CV) disease; whether the elevated risk applies to all types of CV diseases or specific types is unclear. This study examined the association of AAV and adverse CV outcomes compared to the non-AAV population.

Methods — We conducted a population-based, retrospective cohort study of adults (mean age 61 years, 51% female) with a new diagnosis of AAV in Ontario, Canada from 2007 to 2017. Weighted models were used to examine the association of AAV (n = 1,520) and CV events in a matched (1:4) control cohort (n = 5,834). The main outcomes were major adverse CV events (MACE defined as myocardial infarction [MI], stroke or CV death), its components, atrial fibrillation (AF), and congestive heart failure (CHF).

Results — Over a mean follow-up of 3.8 years, AAV (compared to non-AAV) was associated with a higher risk of stroke (cumulative incidence 7.0% vs 5.2%; sub-distribution hazard ratio [sHR] 1.49, 95%CI 1.10–2.02), AF (cumulative incidence 16.4% vs 11.5%; sHR 1.51, 95%CI 1.30–1.75) and CHF (cumulative incidence 20.8% vs 13.3%; sHR 1.41, 95%CI 1.22–1.62), but not for MACE, MI nor CV death. The risks for all CV events, except CV death, were significantly elevated in the early period after AAV diagnosis, in particular AF (365-day sHR 2.06, 95%CI 1.71–2.48; 90-day sHR 3.33, 95%CI 2.66–4.18) and CHF (365-day sHR 1.75, 95%CI 1.48–2.07; 90-day sHR 2.65, 95%CI 2.15–3.26).

Conclusion — AAV is associated with a high risk of certain types of cardiovascular events, particularly in the early period following diagnosis.