Burden of coronary artery calcification in ANCA-associated vasculitis.

IF 5.1 2区医学 Q1 RHEUMATOLOGY

RMD Open Pub Date : 2025-01-06 DOI:10.1136/rmdopen-2024-004774

Michael Hendrickson, Anushri Parakh, Brittany Weber, Claire Cook, Catherine Ahola, Sandeep Hedgire, Michael Lu, Zachary S Wallace

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Abstract

Background: Cardiovascular disease (CVD) is a leading cause of death in ANCA-associated vasculitis (AAV). Screening and primary cardiovascular prevention may improve outcomes.

Methods: We identified patients in the 2002-2019 Mass General Brigham AAV cohort with thoracic CT scans obtained for other clinical purposes. Coronary artery calcium (CAC) scores and age, sex and race-standardised CAC percentiles were calculated. Quantile regression was used to identify differences by ANCA type, and Gray's test examined differences in major adverse cardiac events by CAC score.

Results: Of 175 included patients, 127 (73%) were MPO-ANCA+and 48 (27%) were PR3-ANCA+. The median CAC score was 17 (IQR 0, 334) and CAC percentile was 45 (IQR 0, 78); 65 (39%) patients had CAC of ≥100. The total CAC score was higher in patients with MPO-ANCA+AAV vs PR3-ANCA+AAV (median 24 vs 1, p=0.003), as was the standardised CAC percentile (50th vs 34th, p=0.02). Of 116 (66%) patients with non-zero CAC scores, only 29 (25%) were on a statin. In a time-to-event analysis, CAC of 100 or higher trended towards association with higher risk of major adverse cardiovascular events (χ²=1.9, p=0.16).

Conclusion: A majority of patients with AAV had clinically significant CAC. There were differences in CAC burden among those with MPO-ANCA+AAV versus PR3-ANCA+AAV. Although CAC is associated with CVD risk and an indication for statins, the use was inconsistent. The role of CT imaging to screen for CVD and guide primary prevention in AAV requires further study.

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anca相关性血管炎的冠状动脉钙化负担。

背景：心血管疾病（CVD）是anca相关性血管炎（AAV）的主要死亡原因。筛查和初级心血管预防可改善预后。方法：我们在2002-2019年麻省总医院布里格姆AAV队列中确定了用于其他临床目的的胸部CT扫描患者。计算冠状动脉钙（CAC）评分和年龄、性别和种族标准化的CAC百分位数。分位数回归通过ANCA类型确定差异，Gray检验通过CAC评分检查主要心脏不良事件的差异。结果：175例患者中，MPO-ANCA+ 127例（73%），PR3-ANCA+ 48例（27%）。CAC评分中位数为17 (IQR 0.334)， CAC百分位数为45 (IQR 0.78)；65例（39%）患者CAC≥100。MPO-ANCA+AAV患者的总CAC评分高于PR3-ANCA+AAV患者（中位数24比1，p=0.003），标准化CAC百分位数也较高（第50比34，p=0.02）。在116例（66%）CAC评分非零的患者中，只有29例（25%）使用他汀类药物。在事件发生时间（time-to-event）分析中，CAC≥100与主要心血管不良事件的高风险相关（χ2=1.9, p=0.16）。结论：大多数AAV患者均有临床上显著的CAC。MPO-ANCA+AAV与PR3-ANCA+AAV患者的CAC负担存在差异。尽管CAC与CVD风险相关，也是他汀类药物的适应症，但其使用并不一致。CT成像在CVD筛查和AAV一级预防中的作用有待进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

RMD Open RHEUMATOLOGY-

CiteScore

7.30

自引率

6.50%

发文量

205

审稿时长

14 weeks

期刊介绍： RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.