Roubille Camille, Henriquez Soledad, Mercuzot Cédric, Duflos Claire, Dunogue Bertrand, Briot Karine, Guillevin Loic, Terrier Benjamin, Fesler Pierre
Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France.
PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000 Montpellier, France.
J Clin Med. 2021 May 25;10(11):2299. doi: 10.3390/jcm10112299.
Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age ( = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98-72.68), cardiovascular history ( = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66-25.71), sedentary lifestyle ( = 0.011, OR = 4.50, 95% CI = 1.42-14.29), hypertension ( = 0.017, OR = 5.04, 95% CI = 1.33-19.12), and dyslipidemia ( = 0.03, OR = 3.86, 95% CI = 1.14-13.09). The occurrence of MACEs was associated with the number of CVRFs ( < 0.001), but not with the use of glucocorticoids or cyclophosphamide ( = 0.733 and = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.
尽管抗中性粒细胞胞浆抗体相关性血管炎(AAV)的预后有所改善,但主要源于心血管疾病的死亡率仍居高不下。我们旨在确定心血管危险因素(CVRF)在AAV患者发生主要心血管事件(MACE)中的作用。AAV患者相继被纳入一项前瞻性队列研究,该研究评估了CVRF(男性定义为年龄>50岁,女性定义为年龄>60岁、心血管疾病个人史、吸烟状况、肥胖、糖尿病、血脂异常、高血压和久坐不动的生活方式)、基线及随访期间糖皮质激素和免疫抑制剂的使用情况以及MACE的发生情况。共纳入103例患者,中位随访时间为3.5年。在糖皮质激素和环磷酰胺校正的多变量分析中,MACE的发生与年龄较大(P = 0.001,OR = 14.71,95%CI(置信区间)= 2.98 - 72.68)、心血管病史(P = 0.007,OR(比值比)= 6.54,95%CI = 1.66 - 25.71)、久坐不动的生活方式(P = 0.011,OR = 4.50,95%CI = 1.42 - 14.29)、高血压(P = 0.017,OR = 5.04,95%CI = 1.33 - 19.12)和血脂异常(P = 0.03,OR = 3.86,95%CI = 1.14 - 13.09)相关。MACE的发生与CVRF的数量相关(P < 0.001),但与糖皮质激素或环磷酰胺的使用无关(分别为P = 0.733和P = 0.339)。实施针对可改变的CVRF,特别是高血压、久坐不动的生活方式和血脂异常的筛查和管理计划,可能对AAV患者有益以降低其心血管风险。