257.. Evidence of ultrasound subclinical atherosclerosis in Eosinophilic Granulomatosis with Polyangiitis (EGPA)
Creators: name: Bello1, Federica
name: Emmi1, Giacomo
name: Bettiol1, Alessandra
name: Mattioli1, Irene
name: Urban1, Maria Letizia
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background:</strong> Atherosclerosis is a multifactorial chronic inflammatory process involving the innermost layer of arteries. In addition to traditional risk factors, non-traditional ones, such as systemic inflammation and endothelial activation are determinant in atherosclerosis progression. Patients suffering from anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) display a two-fold incidence of cardiovascular thrombotic events, partially reflecting (o suggesting) the endothelial damage mediated by ANCA and other inflammatory mediators. Intima-media thickness (IMT) has been demonstrated to mirror generalized atherosclerosis and to directly correlate with cardiovascular disease risk. An increased subclinical atherosclerosis (defined as increased IMT and presence of carotid plaques) has been reported in Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA). Eosinophilic Granulomatosis with Polyangiitis (EGPA, formerly known as Churg-Strauss syndrome) is a rare AAV in which eosinophil-mediated manifestations coexist with vasculitic ones. Eosinophils are known to contribute to a prothrombotic state through the release of tissue factor, which initiates coagulation, and cationic proteins which inhibit natural anticoagulant activity and activate platelets. Despite arterial events being more common in EGPA than in normal population, no data exist on subclinical atherosclerosis in these patients. Objective: The present study aims to evaluate accelerated subclinical atherosclerosis in a cohort of EGPA patients by vascular ultrasound assessment of carotid IMT and the presence of carotid plaques. <strong>Methods:</strong> Forty EGPA patients and 80 controls matched by age, gender, and major cardiovascular risk factors were included. All participants underwent sonographic IMT measurement and detection of plaque in the common carotid arteries (CCA). IMT was considered increased when exceeding 0.9 mm, while the presence of carotid plaques was defined as an IMT greater than or equal to 1.3 mm. CCA-IMT levels and the presence of carotid plaques were compared between patients and controls. Furthermore, in the patient’s group, markers of subclinical atherosclerosis were evaluated according to disease phenotype (vasculitic vs eosinophilic), ANCA-status, disease duration, cumulative steroid dose, and immunosuppressive treatments. Patients were also evaluated according to the number of relapses, Vascular Damage Index (VDI) at ultrasound examination, and Five-Factor Score (FFS) at disease onset, which were considered as an expression of disease severity. <strong>Results:</strong> Demographic and clinical characteristics of both EGPA and controls are shown in <em>Figure 1A</em>. No differences in terms of traditional cardiovascular risk factors between EGPA patients and controls. However, CCA-IMT was significantly higher in EGPA compared to controls (median, 1.03 mm vs 0.79 mm; p=0.0002) <em>(Figure 1B)</em>. The proportion of subjects with increased CCA-IMT levels was significantly higher among patients than controls (75% vs 37%; p&lt;0.0001) <em>(Figure 1B)</em>. Also, the presence of carotid plaques was more frequent among EGPA cases (42.5% vs 13.75%; p&lt;0.0001) <em>(Figure 1B)</em>. Within the EGPA cohort, CCA-IMT directly correlated with disease duration (Spearman’s rho 0,034) and with corticosteroid cumulative dose (Spearman’s rho 0,004). No significant differences were found based on immunosuppressive treatment (steroids alone vs DMARDs plus steroids). Also, no significant differences in CCA-IMT levels nor the presence of carotid plaques were found when patients were stratified according to vasculitis phenotype, ANCA-status, number of relapses, VDI, and FFS. When EGPA patients were divided based on the presence or absence of increased IMT, no differences were found in the prevalence of traditional cardiovascular risk factors (data not shown). <strong>Conclusion:</strong> Ultrasound markers of subclinical atherosclerosis are increased in EGPA patients in respect of controls, independently of traditional cardiovascular risk factors. A longer disease duration and a higher cumulative corticosteroid dosage, but not the disease phenotype and severity, seem associated with increased IMT in EGPA patients. <strong>Disclosure:</strong> The Authors have declared no conflicts of interest. <strong>Figure 1.</strong> A- Demographic and clinical features of EGPA patients and controls. B- Comparison of mean CCA-IMT and presence of increased IMT and carotid plaques between EGPA patients vs controls<em>.</em> A. EGPA patients (N; % out of 40) Controls (N;% out of 80) p-value Demographic characteristics Age at disease onset (median (IQR)) 53.0 (43.0 – 62.0) Age at sonographic IMT assessment (median (IQR)) 59 (48-71) 56.0 (45.0 – 69.0) 0.229 Female sex 24 (60.0) 47 (58.8) 1.000 Smoking habit 7 (17.5) 13 (16.3) 1.000 Comorbidities Hypertension 20 (50.0) 35 (43.8) 0.563 Hypercholesterolemia 17 (42.5) 34 (42.5) 1.000 Diabetes 2 (5.0) 5 (6.3) 1.000 Obesity 0 0 - Atrial fibrillation 4 (10.0) 0 n.a. Cancer 3 (7.5) 0 n.a. Disease duration (months) 65 (35-86) Disease manifestations Asthma 40 (100.0) Ear-nose-throat (ENT) involvement 33 (82.5) Peripheral nervous system 24 (60.0) Heart 13 (32.5) Gastrointestinal 8 (20.0) Skin 8 (20.0) Kidney 2 (5.0) Articular 1 (2.5) Ocular 1 (2.5) ANCA positivity 18 (45.0) B. <em>EGPA = eosinophilic granulomatosis with polyangiitis; ANCA= anti-neutrophil cytoplasmic antibodies; CCA = common carotid artery; IMT = intima-media thickness;</em>