Dr. McCune has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Genentech and has received research support from Genentech and Human Genome Sciences.
Special Theme Articles: Vascular Comordibidity in the Rheumatic Diseases
A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis
Version of Record online: 30 MAR 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 4, pages 588–596, April 2011
How to Cite
Suppiah, R., Judge, A., Batra, R., Flossmann, O., Harper, L., Höglund, P., Javaid, M. K., Jayne, D., Mukhtyar, C., Westman, K., Davis, J. C., Hoffman, G. S., McCune, W. J., Merkel, P. A., St.Clair, E. W., Seo, P., Spiera, R., Stone, J. H. and Luqmani, R. (2011), A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis. Arthritis Care Res, 63: 588–596. doi: 10.1002/acr.20433
- Issue online: 30 MAR 2011
- Version of Record online: 30 MAR 2011
- Accepted manuscript online: 14 JAN 2011 03:38PM EST
- Manuscript Accepted: 23 DEC 2010
- Manuscript Received: 11 JUL 2010
- European Vasculitis Study Group trials was funded by a project grant from the European League Against Rheumatism
- The Wegener's Granulomatosis Etanercept Trial was supported by grants fromthe National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: K24-AR049185-01, K24-AR2224-01A1, K24-AR02126-04
- National Center for Research Resources
- Office of Rare Diseases Research. Grant Numbers: 1-U54-RR01949, U54-AR057319, U01-AR1874
- NIH. Grant Number: N01-AR92240
- Office of Orphan Products
- Food and Drug Administration. Grant Number: FD-R-001652
- General Clinical Research Center. Grant Numbers: M01-RRO-00533 to Boston University, M01-RRO-0042 to The University of Michigan, MO1-RR-30 to Duke University, M01-RRO-2719 to Johns Hopkins University School of Medicine
- National Center for Research Resources/NIH
- Rose Hellaby Medical Scholarship, New Zealand
- Oxford National Institute for Health Research Biomedical Research Unit Musculoskeletal Research Group, University of Oxford
- Cambridge Biomedical Research Centre
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.
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.
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).
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.