Assessment of cardiovascular risk in patients with ANCA-associated vasculitis: A systematic review and meta-analysis

Abstract

Background: Although many chronic inflammatory conditions are linked to elevated cardiovascular risk, the specific extent of this risk in ANCA-associated vasculitis (AAV) remains elusive, largely due to the disease's rarity. Our study sought to clarify the cardiovascular risks and mortality linked to AAV. Methods: A systematic literature review was conducted across multiple databases from their inception until April 2024 to identify studies comparing cardiovascular outcomes in patients with and without AAV. R Studio's meta package was used to pool risk ratios under the random-effects model, and statistical significance was set at p < 0.05. Results: Nine observational studies involving 45024 individuals were included in this analysis. Patients with AAV exhibited a significantly elevated risk of stroke (RR = 1.43, 95 % CI: 1.12–1.83, I2 = 62 %, p = 0.0048), myocardial infarction (RR = 1.49, 95 % CI: 1.25–1.79, I2 = 0 %, p < 0.0001), ischemic heart disease (RR = 1.40, 95 % CI: 1.24–1.58, I2 = 1 %, p < 0.0001), venous thromboembolism (RR = 2.57, 95 % CI: 1.70–3.90, I2 = 74 %, p < 0.0001), and pulmonary embolism (RR = 3.53, 95 % CI: 2.82–4.42, I2 = 9 %, p < 0.0001), deep vein thrombosis (RR: 4.21; 95 % CI: 2.00–8.86; p = 0.0002), heart failure (RR = 1.63, 95 % CI: 1.39–1.90, I2 = 0 %, p < 0.0001), and cardiovascular disease-related mortality (RR = 1.79, 95 % CI: 1.07–3.00, I2 = 0 %, p = 0.0256) compared to patients without AAV. Conclusion: This meta-analysis underscores a notable increase in adverse cardiovascular events among patients with AAV, underscoring the need for comprehensive cardiovascular care and diligent monitoring in this patient cohort.

Keywords

• ANCA-Associated vasculitis
• Cardiovascular risk
• Cardiovascular disease-related mortality
• Meta-analysis