Calcium Pyrophosphate Deposition Disease Linked to Major CV Events, Death

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Patients with calcium pyrophosphate deposition (CPPD) disease may be at an increased risk of major adverse cardiovascular events along with a higher mortality rate compared to those without the disease, according to a study presented at annual meeting of the American College of Rheumatology in Atlanta on November 12.

Prior studies have shown that vascular calcification is more common in patients with CPPD disease, which results from precipitation of calcium pyrophosphate crystals in the joints, compared to those without CPPD. While vascular calcification is implicated in the development of cardiovascular disease, studies of cardiovascular risks in CPPD are lacking.

“We aimed to assess the risk of cardiovascular events and all-cause mortality in patients with CPPD versus those without CPPD,” the wrote the authors of the study, presented by Maaman Bashir, M.D., of the Medical College of Wisconsin in Milwaukee.

This retrospective cohort study compared the risk of major adverse cardiovascular events (MACE) in 24,413 male patients with CPPD, defined by ≥1 ICD-9 code for chondrocalcinosis or calcium metabolism disorder, and 97,591 age and sex-matched controls within the national Veterans Affairs database (2010-2014). Participants had at least one healthcare encounter in the 365 days before index date, defined as the first ICD-9 code for CPPD or a matched date for controls. The primary outcome was any MACE, defined by ICD-9 and/or procedure codes for myocardial infarction, acute coronary syndrome, re-vascularization, or ischemic stroke. Secondary outcomes included individual types of MACE and all-cause mortality. 

MACE occurred in 2.88 percent of patients with CPPD and 1.10 percent of controls. The incidence rate per 1,000 person-years of any MACE was nearly three times higher in patients with CPPD (11.5 [95% CI 10.7-12.4]) compared to controls (4.3[95% CI 4.1-4.6]), with incidence rate ratios of 2.66 (95% CI 2.42-2.93).

The incidence rate ratios for each individual type of MACE was also higher in the CPPD group versus the controls. The respective incidence rate ratios were 2.93 (95% CI 2.52-3.40) for myocardial infarction, 2.75 (95% CI 2.45-3.08) for acute coronary syndrome, 2.43 (95% CI 2.04-2.89) for re-vascularization, and 2.48 (95% CI 2.02-3.04) for ischemic stroke.

The results were similar after adjusting for traditional cardiovascular risk factors, including hypertension, hyperlipidemia, diabetes, chronic kidney disease, peripheral vascular disease, smoking, obesity, gout, osteoarthritis, rheumatoid arthritis and prior history of MACE. The incidence rate for all-cause mortality rate was higher in patients with CPPD (57.7 [95% CI 55.7-59.7]) than controls (42.9 [95% CI 42.0-43.7]), with incidence rate ratios of 1.35 (1.29-1.40). In an unadjusted survival analysis, time to death was shorter among CPPD patients than controls (log rank p< 0.0001).

“CPPD was associated with an increased risk of MACE after adjusting for known cardiovascular disease risk factors,” the authors wrote. “Patients with CPPD also had a higher mortality rate compared to patients without CPPD.”

REFERENCE

“L04 - Cardiovascular Disease Risk in Calcium Pyrophosphate Deposition Disease.” Maaman Bashir, M.D., 9 a.m., Tuesday, Nov. 12. 2019 ACR/ARP Annual Meeting, Atlanta