FRI0343 Factors associated with major cardiovascular events in patients with primary systemic necrotizing vasculitides: results of a longitudinal long-term follow-up study
Authors: B. Terrier, C. Pagnoux, G. Chironi, A. Simon, L. Mouthon, L. Guillevin
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Primary systemic necrotizing vasculitides (SNV) were shown to be associated with more frequent subclinical atherosclerosis, independently of cardiovascular (CV) risk factors and C-reactive protein (CRP) level, suggesting that SNV might be associated with a higher risk of major CV events (MCVE). <h3>Objectives</h3> To identify factors predictive of MCVE in SNV patients. <h3>Methods</h3> Consecutive patients in SNV remission were assessed for CV risk factors, body mass index (BMI), CRP levels and subclinical atherosclerosis [ultrasound detection of plaque in peripheral vessels and measurement of carotid intima–media thickness (IMT)], and prospectively followed in the same center. High-risk status, defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III), was a known history of CV disease, diabetes or 10-yr Framingham Risk Score ≥20%. MCVE, defined as myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina and/or death from CV causes, were recorded. Kaplan–Meier MCVE-free survival curves were plotted and compared with the log-rank test. <h3>Results</h3> Thirty-seven patients (24 males, age 54 ± 15 yr) were followed for 7.0 ± 2.6 yr. SNV diagnoses were: granulomatosis with polyangiitis, 19; eosinophilic granulomatosis with polyangiitis, 8; microscopic polyangiitis, 7; and polyarteritis nodosa, 3. Seven (18.9%) patients suffered MCVE, including myocardial infarction or hospitalization for unstable angina (n=4), arterial revascularization (n=2), and CV cause of death (n=1). The respective 5- and 10-yr MCVE rates were 10.8% and 25.7%. Univariate analysis selected NCEP/ATP III-defined high-risk status [hazard ratio (HR) 5.02 (95% CI 1.17–27.4), P=0.03], BMI &gt;30 kg/m<sup>2</sup> [HR 4.84 (95% CI 1.46–116), P=0.02] and plaque detection in the abdominal aorta (P=0.01) as being significantly associated with MCVE. In contrast, SNV characteristics, corticosteroid maintenance therapy, CRP &gt;5 mg/L, and plaque detection in the carotid and femoral arteries were not associated with MCVE. Plaque in the aorta was significantly (X<sup>2</sup>test) associated with high-risk status (P&lt;0.001), while BMI and high-risk status were independent variables (P=0.64). Thus, a BMI &gt;30 kg/m<sup>2</sup> and/or a high-risk status were strongly associated with MCVE (P=0.003). Finally, although IMT was not associated with MCVE, it distinguished between patients with early or lateMCVE: 30% of patients with IMT &gt;0.60 mm (vs none of those with IMT ≤0.60 mm) experienced MCVE within the first 3 yr of follow-up, while 23% of patients with IMT ≤0.60 mm (vs none of those with IMT &gt;0.60 mm) experienced a 1<sup>st</sup> MCVE after 7–10 yr of follow-up. IMT was correlated with the time to MCVE (r<sup>2</sup>=0.78, P=0.008). <h3>Conclusions</h3> These results suggest that factors associated with a higher MCVE risk in SNV patients are NCEP/ATP III-defined high-risk status and BMI &gt;30 kg/m<sup>2</sup>. Carotid IMT measurement in SNV patients could help identify those at risk of early MCVE. <b>Disclosure of Interest</b>: None Declared