Acute crystal arthritis from calcium pyrophosphate deposition contributes to non-fatal CV events: BMJ

USA: In a new study conducted by Sara K Tedeschi and the team, it was observed that acute calcium pyrophosphate deposition (CPPD) crystal arthritis was related to an increased risk of nonfatal cardiovascular (CV) events in both the short and long-term cases. The findings of this study were published in the BMJ journal Annals of the Rheumatic Diseases.

Broadly characterized CPPD conditions have been linked to an elevated risk of cardiovascular events. As a result, this study was carried out to look at the risk of CV events in individuals with acute CPP crystal arthritis, which is an acute symptom of CPPD.

This cohort research employs electronic health record (EHR) data from Mass General Brigham from 1991 to 2017. A published machine learning approach with an 81% positive predictive value was used to identify patients with acute CPP crystal arthritis. Patients with acute CPP crystal arthritis were matched with comparators based on the year of EHR entry and the index date.

MACE was defined as a combination of a non-fatal CV event (acute coronary syndrome, myocardial infarction, coronary revascularization, stroke) and mortality. Researchers calculated incidence rates (IRs) and adjusted hazard ratios for MACE, non-fatal CV events, and mortality, with estimates varying between years 0 and 2. Sensitivity studies included the following individuals: (1) patients having acute CPP crystal arthritis identified during outpatient visits, (2) patients with connected Medicare data from 2007 to 2016, and (3) patients matched on the number of CV risks.

The key findings of this study were as follows:

1. 1200 individuals with acute CPP crystal arthritis were matched with 3810 controls.

2. In acute CPP crystal arthritis, the IR for MACE in years 0-2 was 91/1000 person-years (p-y), compared to 59/1000 p-y in comparators.

3. In years 2-10, the IR for MACE in acute CPP crystal arthritis was 58/1000 p-y and 53/1000 p-y in comparators.

4. Acute CPP crystal arthritis was related to a higher risk of MACE in years 0-2 and a non-fatal CV event in years 2-10, but not mortality.

5. Sensitivity analyses yielded comparable results to the original analysis; in the outpatient-only study, the incidence of non-fatal CVE was considerably higher in years 2-10 but not in years 0-2.

In conclusion, these findings point to an elevated risk of significant cardiovascular events in individuals with CPPD, both in the short and long term. Providers should be aware of the link and treat modifiable risk factors. This research also implies that IL-1 may be involved in cardiovascular disease.

Reference:

Tedeschi, S. K., Huang, W., Yoshida, K., & Solomon, D. H. (2022). Risk of cardiovascular events in patients having had acute calcium pyrophosphate crystal arthritis. In Annals of the Rheumatic Diseases (p. annrheumdis-2022-222387). BMJ. https://doi.org/10.1136/annrheumdis-2022-222387