Yadav Rukesh, Mishra Ashish, Mandal Prince, Karki Susmin, Pokhrel Saurav, Neupane Narayan Prasad
Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal.
Ann Med Surg (Lond). 2025 Feb 7;87(5):2868-2879. doi: 10.1097/MS9.0000000000003011. eCollection 2025 May.
Cardiovascular diseases (CVD) account for a significant portion of deaths in anti-neutrophilic cytoplasmic antibodies associated vasculitis (AAV). Previous studies have shown the presence of accelerated subclinical atherosclerosis and arterial stiffness in AAV patients that is not solely explained by conventional cardiovascular risk factors. Moreover, lipid profile may be deranged in such patients. The evidence of subclinical atherosclerosis, arterial stiffness, and lipid profile have not been analyzed in AAV patients.
PubMed, Google Scholar and Embase databases were searched from inception till January 2024 for studies that measured parameters of arterial structure and function ((carotid intimal media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV)) and lipid profile of adult patients with AAV and matched healthy controls. Outcomes included standardized mean difference (SMD) with 95% confidence interval (CI) of CIMT, FMD, PWV and lipid profile between AAV patients and healthy controls. The analysis was done via Revman 5.1.
Ten studies comprising 360 AAV patients and 487 healthy controls were included in this analysis. CIMT value was significantly higher in AAV patients as compared to healthy controls [SMD = 0.34, CI = 0.09-0.59, = 0.008, I = 56%]. Moreover, PWV was significantly higher in AAV patients [SMD = 0.53, CI = 0.26-0.79, < 0.001, I = 0%] as compared to healthy controls. The lipid profile was not significantly different among the AAV patients and the healthy controls except the total triglycerides level.
This review validates the occurrence of subclinical atherosclerosis and arterial stiffness in AAV patients. Regular assessment using surrogate markers is warranted with aim to reduce CVD in such patients.
心血管疾病（CVD）在抗中性粒细胞胞浆抗体相关性血管炎（AAV）导致的死亡中占很大比例。既往研究表明，AAV患者存在加速的亚临床动脉粥样硬化和动脉僵硬，这不能完全用传统心血管危险因素来解释。此外，此类患者的血脂谱可能紊乱。尚未对AAV患者的亚临床动脉粥样硬化、动脉僵硬和血脂谱证据进行分析。
检索PubMed、谷歌学术和Embase数据库，从建库至2024年1月，查找测量AAV成年患者及匹配健康对照的动脉结构和功能参数（颈动脉内膜中层厚度（CIMT）、血流介导的扩张（FMD）、脉搏波速度（PWV））以及血脂谱的研究。结局包括AAV患者与健康对照之间CIMT、FMD、PWV和血脂谱的标准化均数差（SMD）及95%置信区间（CI）。分析通过Revman 5.1进行。
本分析纳入了10项研究，共360例AAV患者和487例健康对照。与健康对照相比，AAV患者的CIMT值显著更高[SMD = 0.34，CI = 0.09 - 0.59，P = 0.008，I² = 56%]。此外，与健康对照相比，AAV患者的PWV显著更高[SMD = 0.53, CI = 0.26 - 0.79, P < 0.001, I² = 0%]。除总甘油三酯水平外，AAV患者与健康对照的血脂谱无显著差异。
本综述证实了AAV患者存在亚临床动脉粥样硬化和动脉僵硬。有必要定期使用替代标志物进行评估，以降低此类患者的心血管疾病风险。
