Coronary Artery Disease in Granulomatosis with Polyangiitis: a Review

Granulomatosis with polyangiitis is an immunologically mediated small to medium vessel vasculitis associated with the formation of antineutrophil cytoplasmic antibodies. Advances in immunosuppressive therapy have expanded patients’ life expectancy in recent decades and have required an expansion of clinical attention to include management of chronic disease manifestations and long-term comorbidities. Though the heart and coronary arteries specifically are typically not primarily affected in GPA, studies have shown that patients are at an increased risk of cardiovascular and thromboembolic events. In many patients, metabolic risk factors promoting the formation of atherosclerotic plaques are not sufficiently controlled or screened for and potentially exacerbated by undesired treatment effects. This review aims to provide clinical physicians with an overview of the current literature on epidemiology, pathophysiology and prevention of coronary artery disease in the context of granulomatosis with polyangiitis and help to identify and lower the risk of cardiovascular events in this high-risk population.