LAUSR

OBJECTIVES To examine long-term cardiovascular outcomes and temporal trends among patients with ANCA-associated vasculitis (AAV) using Danish nationwide registries. METHODS Using a cohort design, we examined patients with Granulomatosis with polyangiitis [ICD-10: DM31.3] and microscopic polyangiitis [ICD-10: DM3.17] in Denmark from 1996-2018. Hazard Ratios (HRs) of cardiovascular outcomes were compared between patients with AAV and age and gender-matched controls. Counterfactual G-estimation of HRs was performed to estimate 5-year absolute risks. Temporal trends were obtained by grouping cohorts into evenly distributed tertiles according to inclusion year. RESULTS 2306 patients with AAV (median age: 62.9yrs, 52.6% male) were matched with 6918 controls. Median follow-up was 9.5yrs. Patients with AAV had a higher rate of ischemic heart disease (HR 1.86[1.62-2.15]), myocardial infarction (HR 1.62[1.26-2.09]), coronary angiogram (HR 1.64[1.37-1.96]), percutaneous coronary intervention (HR 1.56[1.17-2.07]) and ventricular arrhythmias/implantable-cardioverter-defibrillator (ICD)-implantations (HR 2.04[1.16-3.57]). Similarly, an increased rate of heart failure (HR 2.12[1.77-2.54]), deep vein thrombosis (HR 3.13[2.43-4.05]), pulmonary embolism (HR 4.04[3.07-5.32]), atrial fibrillation (HR 2.08[1.82-2.39]), ischemic stroke (HR 1.58[1.31-1.90]) and in-hospital cardiac arrest (HR 2.27[1.49-3.48]) was observed. The 5-year risk of all outcomes were higher (excluding ventricular arrhythmia/ICD-implantations). For temporal trends among patients with AAV, a decreased 3-year risk of cardiovascular mortality was observed over time. CONCLUSIONS Patients with AAV are at increased risk of heart failure, atrial-/ventricular arrhythmias, venous thrombotic events, ischemic stroke and myocardial infarction. Furthermore, patients with AAV were more frequently examined with coronary procedures and underwent more coronary revascularizations. No temporal changes in ischemic cardiovascular outcomes were observed, albeit the cardiovascular mortality has decreased over time.