OP0058\u2005CARDIOVASCULAR AND CEREBROVASCULAR RISK IN PATIENTS WITH SMALL VESSEL VASCULITIDES: A COMPARATIVE ANALYSIS BETWEEN AORTIC STIFFNESS, CAROTID SONOGRAPHY AND SCORE

Abstract

Cardiovascular (CV) and cerebrovascular (CVB) risk have not been adequately examined in the setting of patients with small vessel vasculitides. In particular, data on CV/CVB surogate markers are scarce and the diagnostic value of traditional CV risk scores, such as the Systematic COronary Risk Evaluation (SCORE) and ist EULAR modified version (mSCORE) is unknown.Aims of this study were to examine gold standard surrogates of CV risk and subclinical atherosclerosis (1), as well as novel duplex-sonographic markers of CVB risk in a cohort of patients with small vessel vasculitides. Moreover, we sought to evaluate for the first time the diagnostic value of SCORE and mSCORE in identifying patients at high CV and CVB risk.SCORE/mSCORE and the gold standard marker of aortic stiffness (carotid-femoral pulse wave velocity; cfPWV) were examined in patients with small vessel vasculitides and healthy controls across 3 Rheumatology Centers. Moreover, sonography of the common- (CCA), internal- (ICA) and external- (ECA) carotid arteries was performed in subsets of both groups, evaluating carotid intima-media-thickness (cIMT), plaque presence and duplex-sonographic indices of CBV risk, such as the resistance- (RI) and pulsatility-index (PI). Disease characteristics, clinical and serological activity markers, as well as traditional CV risk factors were also documented.We recruited 46 patients with small vessel vasculitides [granulomatosis with polyangiitis (n=33), eosinophilic granulomatosis with polyangiitis (n=6), microscopic polyangiitis (n=4), cryoglobulinemic vasculitis (n=1), urticaria vasculitis (n=2): 76.1% female, median age 61.5 years (52-72.25, IQR)] and 105 healthy controls [76.1% female, median age 61.5 years (52-72.25, IQR)]. cfPWV was significantly higher in the patient group compared to the control group, even after statistical corrections for confounding factors (i.e. age, gender: different in the two groups) (8.4 m/s vs. 6.8 m/s; padj<0.001). Moreover, carotid sonography revealed higher CVB surrogates in the patient subgroup, compared to controls.According to SCORE and (EULAR)-mSCORE, 0.9% and 15.8% of the patients had high CV risk (defined as SCORE/mSCORE >5), respectivelly. However, cfPWV revealed an increased CV risk in 28.2% of the patients. Moreover, carotid sonography showed signs of subclinical carotid arteriosclerosis in 50% (plaques) and 71.7% (cIMT >0.9 mm) of the patients, respectively.Herein, we could show that patients with small vessel vasculitides had higher aortic stiffness and subclinical carotid atherosclerosis, compared to controls and could thus have higher CV and CVB risk. Moreover, we were able to demonstrate for the first time that SCORE/mSCORE performed poorly in identifying patients at high CV risk and carotid atherosclerosis compared to cfPWV and carotid sonography respectively. Thus, cfPWV and carotid sonography could improve CV and CBV screening in patients with small vessel vasculitides.Table 1.Descriptive characteristics.Controls(n=105)Patients(n=46)Significance(p)cfPWV† (m/s)6.80 (6.05-7.5)8.40 (7.26-10.66)<0.001*Age† (years)50 (39.50-56.5)61.50 (52-72.25)<0.001*Gender(female)95 (90.5%)35 (76.1%)0.019*Nicotin(smokers)21 (20%)5 (11.1%)0.190Antihypertensive drugs18 (17.1%)27 (65.9%)<0.001*BMI†23.73 (21.1-27.1)25.14 (22.81-28.70)0.074Mean art. pressure¶93.45±10.6896.19±10.680.150ESR† (mm/h)-20.00 (11– 41.5)-ANCA-25 (54.3%)-Creatinine†0.77 (0.72-0.81)0.94 (0.8-1.31)<0.001*Cholesterol¶ (mg/dL)-216.88±40.16 -Prednisolone† (mg)-5.63 (1.75-16.38)-Lung involvement17 (37%)-Kidney involvement17 (37%)-Ear-nose-throat (ENT)16 (34.8%)-†median (IQR): Mann Whitney test¶ mean±standard deviation: t test*p<0.05[1]Vlachopoulos C et al., Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2010 30;55(13):1318-27Konstantinos Triantafyllias Speakers bureau: Pfizer, Novartis, Janssen, Chugai, Leif-Erik Thiele: None declared, Michele De Blasi: None declared, Andreas Schwarting: None declared