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A Model to Predict Cardiovascular Events in Patients With Newly Diagnosed Wegener's Granulomatosis and Microscopic Polyangiitis

Suppiah, Ravi; Judge, Andrew; Batra, Rajbir; Flossmann, Oliver; Harper, Lorraine; Höglund, Peter LU ; Javaid, M. Kassim; Jayne, David; Mukhtyar, Chetan and Westman, Kerstin LU , et al. (2011) In Arthritis Care and Research1988-01-01+01:002000-01-01+01:00 63(4). p.588-596
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... (More)
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. (Less)
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Contribution to journal
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published
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Arthritis Care and Research1988-01-01+01:002000-01-01+01:00
volume
63
issue
4
pages
588 - 596
publisher
John Wiley & Sons
external identifiers
  • wos:000289422700015
ISSN
2151-4658
DOI
10.1002/acr.20433
language
English
LU publication?
yes
id
285dc986-5d4b-4fa9-bafa-32c1f3449c9a (old id 1966046)
date added to LUP
2011-06-01 10:51:15
date last changed
2016-04-15 14:02:21
@article{285dc986-5d4b-4fa9-bafa-32c1f3449c9a,
  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.},
  author       = {Suppiah, Ravi and Judge, Andrew and Batra, Rajbir and Flossmann, Oliver and Harper, Lorraine and Höglund, Peter and Javaid, M. Kassim and Jayne, David and Mukhtyar, Chetan and Westman, Kerstin and Davis, John C., Jr. and Hoffman, Gary S. and McCune, W. Joseph and Merkel, Peter A. and St Clair, E. William and Seo, Philip and Spiera, Robert and Stone, John H. and Luqmani, Raashid},
  issn         = {2151-4658},
  language     = {eng},
  number       = {4},
  pages        = {588--596},
  publisher    = {John Wiley & Sons},
  series       = {Arthritis Care and Research1988-01-01+01:002000-01-01+01:00},
  title        = {A Model to Predict Cardiovascular Events in Patients With Newly Diagnosed Wegener's Granulomatosis and Microscopic Polyangiitis},
  url          = {http://dx.doi.org/10.1002/acr.20433},
  volume       = {63},
  year         = {2011},
}