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.

中文翻译：

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诊断为 ANCA 相关血管炎患者的长期心血管结果和时间趋势：一项丹麦全国登记研究

目的 使用丹麦全国登记处检查 ANCA 相关血管炎 (AAV) 患者的长期心血管结果和时间趋势。方法 使用队列设计，我们检查了 1996 年至 2018 年间在丹麦患有肉芽肿性多血管炎 [ICD-10: DM31.3] 和显微镜下多血管炎 [ICD-10: DM3.17] 的患者。比较了 AAV 患者与年龄和性别匹配的对照组之间心血管结局的风险比 (HR)。对 HR 进行反事实 G 估计以估计 5 年绝对风险。根据纳入年份将队列分组为均匀分布的三分位数，从而获得时间趋势。结果 2306 名 AAV 患者（中位年龄：62.9 岁，52.6% 为男性）与 6918 名对照相匹配。中位随访时间为 9.5 年。AAV 患者的缺血性心脏病发生率更高 (HR 1. 86[1.62–2.15]）、心肌梗塞（HR 1.62[1.26–2.09]）、冠状动脉造影（HR 1.64[1.37–1.96]）、经皮冠状动脉介入治疗（HR 1.56[1.17–2.07]）和室性心律失常/植入-心律转复除颤器 (ICD) 植入 (HR 2.04[1.16–3.57])。同样，心力衰竭 (HR 2.12[1.77–2.54])、深静脉血栓形成 (HR 3.13[2.43–4.05])、肺栓塞 (HR 4.04[3.07–5.32])、房颤 (HR 2.08[1.82]) 的发生率增加–2.39]）、缺血性卒中（HR 1.58[1.31-1.90]）和院内心脏骤停（HR 2.27[1.49-3.48]）。所有结果的 5 年风险均较高（不包括室性心律失常/ICD 植入）。对于 AAV 患者的时间趋势，随着时间的推移观察到 3 年心血管死亡风险降低。结论 AAV 患者发生心力衰竭的风险增加，房性/室性心律失常、静脉血栓事件、缺血性中风和心肌梗塞。此外，AAV 患者更频繁地接受冠状动脉手术检查，并接受更多的冠状动脉血运重建。没有观察到缺血性心血管结果的时间变化，尽管心血管死亡率随着时间的推移而下降。