Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

Abstract

ObjectiveEvidences indicate that the risk of stroke is increased in autoimmune rheumatic diseases. This study aimed to investigate the incidence of stroke in patients with systemic necrotizing vasculitis (SNV) using the national health database.MethodsData were obtained from the Korean National Claims database between 2010 and 2018 to identify incident SNV [anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN)] cases. The standardized incidence ratio (SIR) and incidence rate ratio (IRR) were calculated to estimate the risk of stroke in patients with SNV compared to the general population and among disease subgroups. Time-dependent Cox’s regression analysis was performed to identify risk factors for stroke.ResultsAmong 2644 incident SNV cases, 159 patients (6.0%) were affected by stroke. The overall risk of stroke was significantly higher in patients with SNV compared to the general population (SIR 8.42). Stroke event rates were the highest within the first year of SNV diagnosis (67.3%). Among disease subgroups, patients with microscopic polyangiitis (MPA) exhibited higher IRR compared to PAN (adjusted IRR 1.98). In Cox’s hazard analysis, older age and MPA were associated with higher risk of stroke [hazard ratio (HR) 1.05 and 1.88], whereas the administration of cyclophosphamide, azathioprine/mizoribine, methotrexate, and statins were protective in stroke (HR 0.26, 0.34, 0.49, and 0.50, respectively).ConclusionA considerable number of SNV patients experienced stroke, especially in the early phase of disease. Older age and MPA diagnosis were associated with elevated risk of stroke, while the administration of immunosuppressive agents and statins was beneficial in preventing stroke.

Granulomatosis With Polyangiitis Complicated by Diffuse Alveolar Hemorrhage, Splenic Infarction and Stroke

“…Increased carotid intima-media thickness is also a reason for ischemic stroke in AAV patients [14]. Studies have found that administering immunosuppressive agents and statins was beneficial in primary stroke prevention [15]. Still, in this study, antiplatelet agents (aspirin, clopidogrel) were not found to have protective effects.…”

Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): Part 2 - Treatment of eosinophilic granulomatosis with polyangiitis and diagnosis and general management of AAV

“…Limited AAV-specific data are available for factors associated with cardiovascular and thromboembolic complications, 149–151 154 168 173 178 183 189 treatment of chronic and end-stage kidney disease, 159 163 202 205 family planning, 199 COVID-19 156 179 186 190 193 194 and patient education. 161 Some of the limited evidence is briefly summarised here:…”

Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study

“…However, little is known about the frequency and features of stroke at PSV onset. The frequency of stroke in PSV has been studied in relatively small and heterogeneous cohorts, most commonly retrospectively assessed over the whole disease course [10,[16][17][18][19][20][21][22][23][24][25]). Ischaemic stroke has been described as the most common subtype of stroke in these patients [16,22], but there are limited available data on the frequency of haemorrhagic stroke and cerebral venous thrombosis (CVT) in PSV [26][27][28][29][30], except for CVT in Behçet's disease [31].…”