POS0210 INCREASED RISK FOR CARDIAC AND VASCULAR MORBIDITY IN ANCA-ASSOCIATED VASCULITIS (AAV): LARGE-SCALE PROPENSITY-MATCHED GLOBAL RETROSPECTIVE COHORT STUDY
Authors: S. Klapa, H. Nording, M. Ludwig, S. Arnold, K. Kridin, A. Kerstein-Staehle, R. Ludwig, P. Lamprecht
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In spite of significantly improved therapy during the last years, long-term morbidity and mortality has remained high in ANCA-associated vasculitis (AAV). The main causes of death within the first year after diagnosis are active vasculitis and infections, followed by cardiovascular disease, malignancies and infections during subsequent years [1-3]. Population-based database and cohort analyses suggest an increased risk for major adverse cardiovascular events (MACE) in AAV [4, 5]. <h3>Objectives:</h3> To assess risk of death and cardiovascular outcomes in AAV using a large global electronic health record database for biomedical and clinic research (TriNetX) [6]. <h3>Methods:</h3> In this retrospective cohort study, data samples from an electronic health records database of the US-based TriNetX network were analysed. Patients (aged≥18 years) with the diagnostic codes of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) (International Classification of Diseases [ICD]) and patients without vasculitis as matched control cohort (1:1) were included. Propensity score matching for demographic variables and cardiovascular and metabolic comorbidities was performed to optimize between-group comparability. Hazard ratios (HR) related to death and cardiovascular outcomes (MACE) were calculated by univariate Cox regression after analysis of the matched cohort by the Kaplan-Meier method. <i>P</i> values were determined by the Log-rank test. <h3>Results:</h3> We identified 21.190 patients with GPA and 5.907 with MPA. The unadjusted and adjusted relative risk (RR) of mortality was increased in GPA (RR 17.87%) and MPA (RR 25.85%) compared to matched controls (GPA: HR: 3.010 <i>P</i> &lt; 0.0001, MPA: HR: 3.007, <i>P</i> &lt; 0.0001; <i>Figure 1A).</i> The risks of all screened cardiovascular events were increased in GPA and MPA compared to matched controls (P &lt; 0.0001; <i>Figure 1A</i>) and did not differ when adjusted according to gender, disease duration (first 3 years after diagnosis), and age (patients &lt; 46 years, patients &gt; 64 years). Especially the risk for thromboembolic events was increased compared to matched controls (deep vein thrombosis: GPA HR: 2.819, MPA HR: 3.334; pulmonary embolism: GPA HR: 3.009, MPA HR: 2.997). Compared to GPA, MPA patients had a higher risk for MACE (MPA vs. GPA: 24.38% vs. 23.76%, HR: 1.160 <i>P</i> = 0.0023) and peripheral arterial disease (MPA vs. GPA: 21.38% vs. 21.17%, HR: 1.165 <i>P</i> = 0.0018; <i>Figure 1B</i>). <h3>Conclusion:</h3> In AAV, the risk of death and cardiovascular events were increased. Compared to GPA, MPA was associated with an increased risk for MACE and peripheral arterial disease. <h3>REFERENCES:</h3> [1] Lamprecht P et al. <i>Pathogenetic and clinical aspect of anti-neutrophil cytoplasmic autoantibody-associated vasculitides</i>. Front Immunol. 2018 Apr 9;9:680. [2] Sanchez-Alamo B et al. Long-term outcomes and prognostic factors for survival of patients with ANCA-associated vasculitis. Nephrol Dial Transplant. 2023;38_1655-1665. [3] Flossmann O et al. Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2011;70:488-494. [4] Aviña-Zubieta JA et al. <i>Risk of Myocardial infarction and stroke in patients with granulomatosis with polyangiitis (Wegener's): A population-based study.</i> Arthritis Rheumatol. 2016 Nov;68(11):2752-2759. [5] Massicotte-Azarnioch D et al. <i>Association of anti-neutrophil cytoplasmic antibody-associated vasculitis and cardiovascular events: a population-based cohort</i> study. Clin Kidney J. 2021 Nov 24;15(4):681-692. [6] Palchuk et al. A gobal federated real-world data and analytics platform for research. JAMIA Open 2023;6(2). <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>