Impact of cardiovascular risk factors in antiphospholipid syndrome: an observational study from the Spanish national registry

Moreno-Torres, Víctor; Royuela, Ana; Tarin, Carlos; Castejón, Raquel; Gutiérrez-Rojas, Ángela; Campo, Pedro Durán-Del; Mellor‐Pita, Susana; Tutor-Ureta, Pablo; Sánchez, Enrique; Martínez-Urbistondo, María; Mendoza, Carmen de; Vargas-Núñez, Juan-Antonio; Ruíz-Irastorza, Guillermo

doi:10.55563/clinexprheumatol/h2tkx3

Cited by 3 publications

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“…In our study, only 16 of 110 APS patients and 35 of 110 HC were without any concomitant traditional CVRF. This is in agreement with previous studies, including two from national cohorts [ 5 , 37 ], that showed a high prevalence of CVRFs in APS patients, higher than that in matched healthy individuals for the majority of CVRFs. It has been previously shown that PAPS patients without traditional CVRFs have endothelial function comparable to that of HC [ 38 ].…”

Section: Discussionsupporting

confidence: 93%

Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome

et al. 2023

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Objectives Cardiovascular disease is a major cause of morbidity and mortality in antiphospholipid syndrome (APS). Arterial stiffness (ArS) has emerged as predictor of future cardiovascular events in the general population. We aimed to assess ArS in patients with thrombotic APS versus diabetes mellitus (DM) and healthy controls (HC), and identify predictors of increased ArS in APS. Methods ArS was evaluated by carotid-femoral Pulse Wave Velocity (cfPWV) and Augmentation Index normalized to 75 beats/min (AIx@75), using the SphygmoCor device. Participants also underwent carotid/femoral ultrasound for atherosclerotic plaques detection. We used linear regression to compare ArS measures among groups and assess ArS determinants in APS group. Results We included 110 patients with APS (70.9% female, mean age: 45.4 years), 110 DM patients and 110 HC, all age/sex matched. After adjustment for age, sex, cardiovascular risk factors and plaque presence, APS patients exhibited similar cfPWV (beta=-0.142, 95% CI: -0.514–0.230, p= 0.454) but increased AIx@75 (beta = 4.525, 1.372–7.677, p= 0.005) compared with HC, and lower cfPWV (p< 0.001) but similar AIx@75 (p= 0.193) vs DM patients. In APS group, cfPWV was independently associated with age (beta = 0.056, 0.034–0.078, p< 0.001), mean arterial pressure (MAP) (beta = 0.070, 0.043–0.097, p< 0.001), atherosclerotic femoral plaques (beta = 0.732, 0.053–1.411, p= 0.035) and anti-β2GPI IgM positivity (beta = 0.696, 0.201–1.191, p= 0.006). AIx@75 was associated with age (beta = 0.334, 0.117–0.551, p= 0.003), female sex (beta = 7.447, 2.312–12.581, p= 0.005) and MAP (beta = 0.425, 0.187–0.663, p= 0.001). Conclusion APS patients exhibit elevated AIx@75 versus HC, and similar to DM, indicating enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS.

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Section: Discussionsupporting

confidence: 93%

Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome

et al. 2023

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“…RMD Open RMD Open RMD Open life-threatening complications due to arterial thrombosis in the coronary, cerebrovascular and/or pulmonary circulation, 3 supporting the need for strict control of risk factors associated with their development and recurrence. 2 4 Hypertension and hyperlipidaemia have been recognised as independent predictors of recurrent thromboses in APS, [5][6][7][8][9] including cardiovascular events. 8 10 However, a high prevalence of unachieved blood pressure (BP) and lipid targets has been documented in patients with APS.…”

Section: What This Study Addsmentioning

confidence: 99%

Application of EULAR and European Society of Cardiology recommendations with regard to blood pressure and lipid management in antiphospholipid syndrome

et al. 2023

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BackgroundTo examine blood pressure (BP) and lipid treatment eligibility in antiphospholipid syndrome (APS) according to European Alliance of Associations for Rheumatology (EULAR) and European Society of Cardiology (ESC) recommendations.MethodsSystematic Coronary Risk Evaluation (SCORE), modified-SCORE, diabetes mellitus (DM)-equivalent risk classifiers (DIME) and disease-related classifiers –type of thrombotic events (APSevents), antiphospholipid-antibody profile (aPLprofile) and adjusted Global APS Score for cardiovascular disease– were used to calculate predicted low-moderate, high and very-high cardiovascular risk (CVR) in 111 patients with APS without prior atherosclerotic cardiovascular events or DM. Actual CVR (AR) was determined according to ESC guidelines, including carotid/femoral plaque presence. In low-moderate SCORE-predicted risk patients, classification ability and agreement for BP or lipid treatment was tested with Matthews’ correlation coefficient (MCC) and Cohen’s kappa, respectively, using the AR classes as reference qualifiers.ResultsSCORE underestimated high/very-high-AR in >50% of cases. SCORE-guided BP/lipid treatment eligibility was 4.2%/12.6% for high, 10.5%/16.8% for very-high AR patients, while 5.3% of low-moderate AR cases were eligible for lipid-lowering therapy. For BP treatment, MCC was higher using DIME for low-moderate and very-high-risk (0.33 and 0.32, respectively), and using modified-SCORE+APSevents(MCC=0.25) for high-risk patients. Eligibility agreement was better with DIME+APSevents or aPLprofile(kappa=0.51) for high-risk, and DIME (kappa=0.31) for very-high-risk patients. For lipid treatment, both classification ability and eligibility agreement were stronger with SCORE (or modified-SCORE)+APSeventsin low-moderate (MCC/kappa=0.43/0.41) and very-high risk (MCC/kappa=0.30/0.30), and with DIME+aPLprofile(MCC/kappa=0.50/0.50) in high-risk patients, respectively.ConclusionMultimodal risk assessment including disease-related and cardiometabolic features used for high-risk diseases such as DM can improve CVR management in APS.

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Predictors of in-hospital mortality in HIV-infected patients with COVID-19

Moreno-Torres

Mendoza

Martínez-Urbistondo

et al. 2022

QJM: An International Journal of Medicine

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Background Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with HIV (PWH) with COVID-19 is under debate. Methods Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list. Results A total of 117,694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs 66.5 years-old; p < 0.001) and more frequently male (74.8% vs 56.6%; p < 0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia, cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs 4.4%; p < 0.001). In-hospital mortality was lower in PWH (9.4% vs 16%; p = 0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (RR: 7.6) were the major determinants of death in PWH hospitalized with COVID-19. Conclusion HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.

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Impact of cardiovascular risk factors in antiphospholipid syndrome: an observational study from the Spanish national registry

Cited by 3 publications

References 0 publications

Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome

Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome

Application of EULAR and European Society of Cardiology recommendations with regard to blood pressure and lipid management in antiphospholipid syndrome

Predictors of in-hospital mortality in HIV-infected patients with COVID-19

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