Predictors of cardiovascular events in patients with primary systemic vasculitis: A 5 years prospective observational study.

INTRODUCTION: Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated systemic vasculitis and is characterised by inflammation of blood vessels. Systemic vasculitis exhibits an enhanced cardiovascular morbidity and cardiovascular disease (CVD) has become a leading cause of death in this group of patients. OBJECTIVES: The aim of the present study was to assess the prevalence of clinical manifestation of atherosclerosis and its relation with classic risk factors for atherosclerosis, echocardiographic parameters and laboratory findings in GPA patients. PATIENTS AND METHODS: The group of consecutive patients with GPA were followed in the study. RESULTS: One hundred six patients with GPA (mean age 50.4 ± 14.9 yrs, 67 female) were prospectively followed for 5.1 ± 1.6 yrs. In 19 patients (18%) cardiovascular disease (9 acute coronary syndromes, 4 symptomatic peripheral vascular diseases and 6 strokes) occurred in association with GPA. In a multivariate model, only age was predictive of cardiovascular events in this group of patients (OR=1.078, 95% CI: 1.025-1.134, p = 0.003). During observation in patients without CVD the level of hs-CRP and D-dimer were significantly reduced on the follow-up visit (p = 0.041, p = 0.0002). On the other hand, in patients with CV events there was no significant differences in both markers' concentrations despite clinical remission. CONCLUSIONS: The age was the only independent predictor of cardiovascular events. Persistent elevation of inflammatory and prothrombotic markers despite clinical remission of the disease could be an indicator of premature atherosclerosis development in patients with systemic vasculitis.

High incidence of venous thromboembolism but not of coronary artery disease in granulomatosis with polyangiitis in first years after diagnosis.

Objectives: Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitis. In patients with GPA an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. The aim of the present study was to assess the incidence of VTE and its relation with classic risk factors for atherosclerosis, presence of coronary artery disease (CAD), echocardiographic parameters and laboratory findings in GPA patients. Methods: The group of consecutive patients with GPA were followed in the study. In all patients echocardiography and laboratory tests were performed. Results: Ninety six patients with GPA were followed for mean 3 years. In 16 patients (16.6%) VTEs occurred in association with GPA, of which 56% occurred 6 months before or one year after diagnosis of GPA. Classic risk factors for atherosclerosis were present in 77 patients (80.2%) at some moment during follow-up. In patients with VTE there were larger right ventricle diameter (p=0.041) and higher right ventricle systolic pressure (p=0.022) observed. VTEs occurred significantly less frequently in patients treated with cyclophosphamide (p=0.049). In this study group VTE occurred more frequently than CAD: 16 (16.7%) vs. 4 (4.2%); p=0,0049. Patients with VTE were younger than those with CAD (p=0.053) and had higher levels of ANCA-PR 3 (p=0.016). Conclusions: Patients with granulomatosis with polyangiitis in first years after diagnosis have higher risk of venous thromboembolism than coronary artery disease. This finding is probably related to hypercoagulability induced by the disease and its therapy.