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A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis

  1. Ravi Suppiah1,*,
  2. Andrew Judge2,
  3. Rajbir Batra2,
  4. Oliver Flossmann3,
  5. Lorraine Harper4,
  6. Peter Höglund5,
  7. M. Kassim Javaid2,
  8. David Jayne3,
  9. Chetan Mukhtyar6,
  10. Kerstin Westman5,
  11. John C. Davis Jr.7,
  12. Gary S. Hoffman8,
  13. W. Joseph McCune9,†,
  14. Peter A. Merkel10,
  15. E. William St.Clair11,
  16. Philip Seo12,
  17. Robert Spiera13,
  18. John H. Stone14,
  19. Raashid Luqmani15

Article first published online: 30 MAR 2011

DOI: 10.1002/acr.20433

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 63, Issue 4, pages 588–596, April 2011

Additional Information

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

Author Information

  1. 1

    Nuffield Orthopaedic Centre, Oxford, UK

  2. 2

    Oxford National Institute for Health Research and University of Oxford, Oxford, UK

  3. 3

    Addenbrooke's Hospital, Cambridge, UK

  4. 4

    University of Birmingham, Birmingham, UK

  5. 5

    Lund University, Lund, Sweden

  6. 6

    Norfolk and Norwich University Hospital, Norwich, UK

  7. 7

    Genentech Corporation, South San Francisco, and University of California, San Francisco

  8. 8

    Cleveland Clinic, Cleveland, Ohio

  9. 9

    University of Michigan, Ann Arbor

  10. 10

    Boston University School of Medicine, Boston, Massachusetts

  11. 11

    Duke University, Durham, North Carolina

  12. 12

    Johns Hopkins University, Baltimore, Maryland

  13. 13

    Hospital for Special Surgery, New York, New York

  14. 14

    Massachusetts General Hospital, Boston

  15. 15

    Nuffield Orthopaedic Centre, Oxford National Institute for Health Research, and University of Oxford, Oxford, UK

  1. †

    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.

*Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK

  1. †

    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.

Publication History

  1. Issue published online: 30 MAR 2011
  2. Article first published online: 30 MAR 2011
  3. Accepted manuscript online: 14 JAN 2011 03:38PM EST
  4. Manuscript Accepted: 23 DEC 2010
  5. Manuscript Received: 11 JUL 2010

Funded by

  • 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

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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.

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