FRI0263 GRANULOMATOSIS WITH POLYANGIITIS, (GPA): CARDIOVASCULAR MORBIDITY AND MORTALITY IN A POPULATION-BASED COHORT. A DANISH REGISTER STUDY
Authors: Helle Laustrup, Anne Voss
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> In order to understand and ultimately prevent cardiovascular (CV) morbidity and mortality in systemic inflammatory disorders we studied the epidemiology of CV disease in ANCA associated Vasculitis (AAV). There is growing evidence that both premature and pronounced atherosclerosis is associated with ANCA associated vasculitis (AAV) <sup>1-3</sup>. However, the exact mechanisms for CV involvement are unknown and probably multiple. <h3>Objectives:</h3> To investigate if CV related comorbidity and death were increased among Danish AAV patients registered with a diagnosis of granulomatosis with polyangiitis (GPA) in Denmark. To investigate if there was a temporal relation between diagnosis of GPA and CV disease and death. <h3>Methods:</h3> A population-based cohort study was performed using the Danish Civil Registration System, the Danish National Patient Registry (all in-patient and out-patient contacts are registered with ICD diagnosis since 1995) and the Danish Cause of Death Register. Patients registered twice or more with a diagnosis of GPA (ICD8: 446.29 and ICD10: M313) during 1995-2016 were included. Annual incidence rate (IR), point prevalence (PP) and standardized mortality rate (SMR) were calculated. The entire adult population in Denmark served as control population. CV morbidity was divided into heart failure (HF) (ICD-10 code I42, I50, J81 and I110) and myocardial infarction (MI) (ICD-10 code I21-25). Death caused by CV disease (ICD-10 code I1-999) was registered. <h3>Results:</h3> We identified 1829 individuals with GPA. The median annual IR was 20.5/1,000,000 and PP was 277/1,000,000 in 2015. Overall SMR was 2.14. Among patients with GPA 171 had a hospital diagnosis of MI. Compared to the control population, the hazard ratio (HR) of MI was 2.47 (95% CI 4.55-11.46) during the first 3 months after the GPA diagnosis. From 3 months to one year declining to 1.41 (95%CI 0.80-2.49) and after 10 years the HR was still slightly increased to 1.64 (95%CI 1.20-2.23). The risk of a diagnosis of HF was markedly increased with a HR at 7.22 (95% CI 4.55-11.46) during the first 3 months after a GPA diagnosis, after three months up to one year 2.94 (95%CI 1.87-4.69), and 2.07 (95% CI 1.54-2.78) after 10 years. The total number of CV deaths in the GPA cohort was 307. During the first three months after a GPA diagnosis, the HR was increased to 9.51 (95%CI 7.12-12.70) declining to 2.51 (95% CI 1.77-3.58) after one year, but still increased to 1.56 (95% CI 1.23-1.98) after 10 years. <h3>Conclusion:</h3> In a population-based study we found an overall increased SMR. The risk of CV comorbidity and of CV death among patients with a register diagnosis of GPA was increased. There was a striking temporal relation between a high HR of CV morbidity and mortality during the first year after the diagnosis of GPA. Nevertheless, the HR of CV morbidity and mortality was albeit lower still increased after 10 years with a diagnosis of GPA. The result indicates a strong association between systemic vascular inflammatory disease and CV involvement. A the time of diagnosis of GPA systemic inflammatory activity usually is present and the results point towards an association of inflammation with CV risk-factors probably including premature and pronounced atherosclerosis. The persistence of increased HR of CV involvement after 10 years indicates a permanent influence on the risk factors. <h3>References:</h3> [1] Mayo Clin Proc2018; 93(5):597-606. [2] Arthritis Rheum2009; 60(4):1187-1192. [3] J Autoimmun2019; 96:134-141. <h3>Disclosure of Interests:</h3> None declared