Cardiovascular disease risk in calcium pyrophosphate deposition disease: A nationwide study of veterans

Objectives Calcium pyrophosphate deposition (CPPD) disease represents a common crystalline arthritis with a range of manifestations. We investigated risks for cardiovascular events in patients with CPPD. Methods We performed a retrospective matched cohort analysis in the Veterans Health Administration Corporate Data Warehouse, 2010-2014. CPPD was defined by ≥1 ICD-9 code for chondrocalcinosis or calcium metabolism disorder. CPPD patients were age- and sex-matched to approximately 4 patients without codes for CPPD; we excluded patients with a cardiovascular event during the 365 days prior to index date. Demographics, traditional cardiovascular risk factors, medications, and healthcare utilization were assessed at baseline. The primary outcome was major adverse cardiovascular event (MACE: myocardial infarction, acute coronary syndrome, coronary re-vascularization, stroke, or death). Secondary outcomes included individual components of MACE. Cox proportional hazards models estimated fully-adjusted hazard ratios (HR) and 95% CI. Results We identified 23,124 CPPD patients matched to 86,629 non-CPPD patients with >250,000 person-years of follow-up. The study population was 96% male, mean age 78 years, and 75% White. The frequency of traditional CV risk factors was similar between the two cohorts. CPPD was not significantly associated with risk for MACE (HR 0.98, 95% CI 0.94, 1.02) in fully-adjusted models, though risks of myocardial infarction, acute coronary syndrome, and stroke were significantly higher in the CPPD cohort compared to non-CPPD cohort. Conclusions CPPD did not confer increased risk for MACE, a composite endpoint including all-cause mortality. Our results propose CPPD as a novel risk factor for myocardial infarction, acute coronary syndrome, and stroke.