A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis
Open Access
- 14 January 2011
- journal article
- research article
- Published by Wiley in Arthritis Care & Research
- Vol. 63 (4), 588-596
- https://doi.org/10.1002/acr.20433
Abstract
Objective To create a prognostic tool to quantify the 5‐year cardiovascular (CV) risk in patients with newly diagnosed Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) without premorbid CV disease. Methods We reviewed CV outcomes during the long‐term followup of patients in the first 4 European Vasculitis Study Group (EUVAS) trials of WG and MPA. CV events were defined as CV death, stroke, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Logistic regression was performed to create a model to predict the absolute risk of a CV event. The model was tested using the Wegener's Granulomatosis Etanercept Trial (WGET) cohort. Results Seventy‐four (13.8%) of 535 patients with 5 years of followup from the EUVAS trials had at least 1 CV event: 33 (11.7%) of 281 WG versus 41 (16.1%) of 254 MPA. The independent determinants of CV outcomes were older age (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.11–1.90), diastolic hypertension (OR 1.97, 95% CI 0.98–3.95), and positive proteinase 3 (PR3) antineutrophil cytoplasmic antibody (ANCA) status (OR 0.39, 95% CI 0.20–0.74). The model was validated using the WGET cohort (area under the receiver operating characteristic curve of 0.80). Conclusion Within 5 years of diagnosis of WG or MPA, 14% of patients will have a CV event. We have constructed and validated a tool to quantify the risk of a CV event based on age, diastolic hypertension, and PR3 ANCA status in patients without prior CV disease. In patients with vasculitis, PR3 ANCA is associated with a reduced CV risk compared to myeloperoxidase ANCA or negative ANCA status.Keywords
This publication has 42 references indexed in Scilit:
- Microvascular Responses to Cardiovascular Risk FactorsMicrocirculation, 2010
- Increased incidence of cardiovascular events in patients with antineutrophil cytoplasmic antibody–associated vasculitides: A matched‐pair cohort studyArthritis & Rheumatism, 2009
- An independent external validation and evaluation of QRISK cardiovascular risk prediction: a prospective open cohort studyBMJ, 2009
- Epidemiological features of Wegener's granulomatosis and microscopic polyangiitis: two diseases or one ‘anti‐neutrophil cytoplasm antibodies‐associated vasculitis’ entity?APMIS, 2009
- General Cardiovascular Risk Profile for Use in Primary CareCirculation, 2008
- Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort studyBMJ, 2007
- Damage caused by Wegener's granulomatosis and its treatment: Prospective data from the Wegener's Granulomatosis Etanercept Trial (WGET)Arthritis & Rheumatism, 2005
- Explained Variance in Logistic RegressionSociological Methods & Research, 2002
- Endothelial vasodilator dysfunction: Pathogenetic link to myocardial ischaemia or epiphenomenon?The Lancet, 1996
- Cardiovascular disease risk profilesAmerican Heart Journal, 1991