Assessment of the frequency of cardiovascular risk factors in patients with Takayasu’s arteritis

Alıbaz-Öner, Fatma; Koster, Matthew J.; Ünal, Ali; Yıldırım, H.G.; Çıkıkçı, Ceylan; Schmidt, J.; Crowson, Cynthia S.; Makol, Ashima; Ytterberg, Steven R.; Matteson, Eric L.; Direşkeneli, Haner; Warrington, Kenneth J.

doi:10.1093/rheumatology/kex300

Cited by 34 publications

(35 citation statements)

References 25 publications

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“…However, we also did not observe a significant association between the use of aspirin and risk of cardiovascular events. The effect of aspirin seems controversial, with another study reporting no significant effect of aspirin on the risk of cardiovascular events [4], consistent with our present study. Aspirin and statins are commonly used for cardioprotection; therefore, their effects are likely to be confounded by indication.…”

Section: Discussionsupporting

confidence: 88%

Disease-specific factors associated with cardiovascular events in patients with Takayasu arteritis

Kwon

Park

et al. 2020

Arthritis Res Ther

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Background: To identify disease-specific factors associated with cardiovascular events in patients with Takayasu arteritis (TAK). Methods: Patients with TAK who fulfilled the American College of Rheumatology 1990 criteria for the classification of TAK and were followed up between 2006 and 2019 were included. Traditional cardiovascular risk factors and TAK disease-specific factors at the index date and incident cardiovascular events during the follow-up were retrospectively assessed. To estimate the risk of cardiovascular events according to TAK disease-specific factors, Cox regression analysis with adjustment for traditional cardiovascular risk factors was performed. Results: Of the total 207 patients with TAK, cardiovascular events occurred in 41 (19.8%) patients. Compared with patients who did not develop cardiovascular events, patients who developed cardiovascular events were older (38.5 ± 13.4 years vs. 43.6 ± 11.8 years, p = 0.028), more commonly had diabetes mellitus (6.6% vs. 19.5%, p = 0.029), had lower high-density lipoprotein cholesterol (57.3 ± 17.1 mg/dl vs. 51.2 ± 15.7 mg/dl, p = 0.040), more commonly had type V vascular involvement (33.1% vs. 63.4%, p 0.001), and less commonly received methotrexate (65.1% vs. 43.9%, p = 0.013). In Cox regression analysis, type V vascular involvement was significantly associated with increased risk of cardiovascular events (adjusted HR 2.852, 95% CI 1.474-5.518, p = 0.002), whereas the use of methotrexate was associated with reduced risk of cardiovascular events (adjusted HR 0.515, 95% CI 0.268-0.993, p = 0.047). Conclusion: Type V vascular involvement was associated with increased risk of cardiovascular events, while the use of methotrexate was associated with reduced risk of cardiovascular events, in patients with TAK.

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Section: Discussionsupporting

confidence: 88%

Disease-specific factors associated with cardiovascular events in patients with Takayasu arteritis

Kwon

Park

et al. 2020

Arthritis Res Ther

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“…A recent paper highlighted increased incident cardiovascular events as well as higher Framingham Risk scores in a large cohort of patients with TA; higher risk (HR 4.36, 95% CI 1.25–15.13) for cardiovascular events was noted in TA when compared with the general population. This reinforces the needs to address cardiovascular risk factors in addition to hypertension in patients with TA . In this context, a recent study demonstrated beneficial effects of exercise in six patients with TA, with reductions in inflammatory cytokine TNF‐α and increase in levels of angiogenic factors in peripheral blood following a 12‐week exercise program .…”

Section: Comorbidities Associated With Uncontrolled Disease Activity mentioning

confidence: 55%

Recent advances in the management of Takayasu arteritis

et al. 2019

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Takayasu arteritis (TA) is a challenging large vessel vasculitis to treat. Distinguishing disease activity from vascular damage is difficult, often relying on clinician judgement aided by composite clinical disease activity indices with angiographic evidence of vessel wall thickening or vessel wall hypermetabolism demonstrable on positron emission tomography computerized tomography (PET CT). Glucocorticoids form the mainstay of remission induction. While other conventional disease modifying anti-rheumatic drugs (cDMARDs) or biologic DMARDs (bDMARDs) are commonly used, evidence supporting their usefulness is sparse and generally of low quality. The only two randomized controlled trials (RCT) of a DMARD in TA failed to show efficacy of abatacept in reducing relapses of TA, however, tocilizumab showed a trend towards reduction in time to relapses. Of the cDMARDs, methotrexate, azathioprine, mycophenolate mofetil (MMF), leflunomide and cyclophosphamide have shown clinical efficacy in case series, with some evidence that methotrexate, azathioprine and MMF might retard angiographic progression. Among bDMARDs, anti-tumor necrosis factor alpha agents and tocilizumab may be useful in patients refractory to cDMARDs with retardation of angiographic progression, based on evidence derived from mostly retrospective case series, whereas the role of rituximab and ustekinumab needs further elucidation. Revascularization, either surgical or endovascular, is the treatment of choice to relieve critical, symptomatic stenoses and are best undertaken during inactive disease. Emerging evidence suggests that patients with TA also have increased cardiovascular risk and this requires appropriate management. Large studies involving multiple centers are the need of the hour to appropriately evaluate utility of currently available immunosuppressive therapy in TA.

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“…АГ традиционно относится к ФР сосудистых осложнений и определяется в 45-85% случаев АТ [2]. Данные представленной когорты полностью соответствуют результатам, полученным в других популяциях [2,5].…”

Section: Discussionunclassified

“…Высокий риск развития КВО среди пациентов АТ при оценке по алгоритму SCORE (Systematic Coronary Risk Evaluation) неоднократно отмечался в последние годы [5]. Однако наличие избыточной массы тела и инсулинорезистентности, а также неконтролируемая высокая активность заболевания ассоциировалась с еще более высоким риском развития МАСЕ, не учитываемым SCORE [7,8].…”

Section: Discussionunclassified

Predictors of cardiovascular complications in patients with Takayasu’s arteritis: results of a retrospective study and analysis of autopsy materials

Borodina

Попов

Шардина

et al. 2019

Cardiovasc Ther Prev

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Цель. Проанализировать структуру и предикторы сердечнососудис тых осложнений (ССО) у пациентов, страдающих артериитом Такаясу (АТ). Материал и методы. Обследованы 183 больных АТ, проходивших лечение в Свердловской клинической областной больнице № 1 в период с 01.01.1979 по 31.04.2018гг, и проанализированы результаты 22 аутопсий пациентов с АТ, умерших за этот же промежуток времени. Результаты. По данным ретроспективного исследования 72 (39%) пациентов из 183 имели ССО. Согласно результатам, неблагоприятными предикторами ССО оказались: мужской пол (p=0,002), курение (p=0,002), оперативные вмешательства до развития события (p=0,002), артериальная гипертензия (p=0,011), симптомы коронариита (p<0,001), головная боль в дебюте заболевания (p=0,028). В структуре причин смерти превалировали сосудистые осложнения-82% случаев. По данным материалов аутопсий у 21 (96%) пациента были обнаружены ате-росклеротические поражения артерий в сочетании со специфическими для АТ изменениями. Тромбозы артерий и вен были выявлены у 17 (77%) пациентов. Заключение. Пациенты с АТ имеют высокий риск развития тяжелых ССО, вплоть до летальных, и требуют особого внимания врача к мерам профилактики. Ключевые слова: артериит Такаясу, сосудистые осложнения, тромбоз, предикторы, оценка риска. Конфликт интересов: не заявлен.

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Assessment of the frequency of cardiovascular risk factors in patients with Takayasu’s arteritis

Cited by 34 publications

References 25 publications

Disease-specific factors associated with cardiovascular events in patients with Takayasu arteritis

Disease-specific factors associated with cardiovascular events in patients with Takayasu arteritis

Recent advances in the management of Takayasu arteritis

Predictors of cardiovascular complications in patients with Takayasu’s arteritis: results of a retrospective study and analysis of autopsy materials

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