Table 6_ANCA-associated vasculitis is associated with an increased risk of cardiac and vascular morbidity: results of a large-scale propensity-matched global retrospective cohort study.docx

IntroductionDespite significantly improved therapies in recent years, long-term morbidity and mortality in ANCA-associated vasculitis (AAV) remain high. The leading causes of death within the first year after diagnosis are active vasculitis and in subsequent years cardiovascular diseases, malignancies, and infections. Population-based database and cohort analyses suggest an increased risk for major adverse cardiovascular events (MACE) in AAV.
MethodsThis retrospective cohort study analyzed data samples from an electronic health records database of the US-based TriNetX network. Patients with the diagnostic codes granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) and patients without vasculitis as a matched control cohort (1:1) were included. To optimize between-group comparability, propensity score matching was performed for demographic variables and comorbidity. Hazard ratios (HR) for death and cardiovascular outcomes were calculated using univariate Cox regression after analyzing the matched cohort using the Kaplan-Meier method.
ResultsWe identified 20, 422 patients with GPA and 5, 907 with MPA. Mortality was more frequent in patients with GPA (17.87%) and MPA (25.85%) than in matched controls (GPA controls: 5.79%; MPA controls: 9.70%), corresponding to an increased hazard of death in both cohorts (GPA: HR 3.01; MPA: HR 3.01). The risk of cardiovascular events was increased in GPA and MPA compared to matched controls, particularly for MACE (GPA: HR: 1.94, MPA: HR: 2.24) and thromboembolic events (deep vein thrombosis: GPA HR: 2.82, MPA HR: 3.33; pulmonary embolism: GPA HR: 3.01, MPA HR: 3.00) and did not differ when adjusted according to sex, disease duration, and age. Compared with GPA patients, MPA patients had a higher risk of MACE (HR: 1.13) and peripheral arterial disease (HR: 1.17).
ConclusionAAV was associated with an increased risk of death and cardiovascular events. Compared with GPA, MPA was associated with an increased risk for MACE and peripheral arterial disease.

引言：尽管近年来治疗手段已有显著改善，但抗中性粒细胞胞浆抗体相关性血管炎（ANCA-associated vasculitis, AAV）患者的长期患病率与死亡率仍居高不下。确诊后第一年的主要死亡诱因为活动性血管炎，后续年份的主要死因则为心血管疾病、恶性肿瘤与感染。基于人群的数据库与队列研究分析显示，AAV患者发生主要不良心血管事件（major adverse cardiovascular events, MACE）的风险升高。
方法：本回顾性队列研究对美国TriNetX网络的电子健康记录数据库中的数据样本进行了分析。纳入符合诊断标准的肉芽肿性多血管炎（granulomatosis with polyangiitis, GPA）患者、显微镜下多血管炎（microscopic polyangiitis, MPA）患者，以及以1:1比例匹配的无血管炎患者作为对照队列。为优化组间可比性，针对人口统计学变量与合并症进行了倾向得分匹配。采用Kaplan-Meier法对匹配队列进行分析后，通过单变量Cox回归计算死亡与心血管结局的风险比（hazard ratio, HR）。
结果：本研究共纳入20422例GPA患者与5907例MPA患者。GPA患者（17.87%）与MPA患者（25.85%）的死亡率均高于匹配对照组（GPA对照组：5.79%；MPA对照组：9.70%），对应两个队列的死亡风险均升高（GPA组：风险比3.01；MPA组：风险比3.01）。与匹配对照组相比，GPA与MPA患者的心血管事件风险均升高，尤其是主要不良心血管事件（GPA组：风险比1.94，MPA组：风险比2.24）与血栓栓塞事件（深静脉血栓形成：GPA组风险比2.82，MPA组3.33；肺栓塞：GPA组3.01，MPA组3.00）；且按性别、病程与年龄校正后，该差异未发生改变。与GPA患者相比，MPA患者发生主要不良心血管事件（风险比1.13）与外周动脉疾病（风险比1.17）的风险更高。
结论：AAV与死亡及心血管事件风险升高相关。与GPA相比，MPA患者发生主要不良心血管事件与外周动脉疾病的风险更高。