Vascular calcification (VC) is a common complication of Takayasu’s arteritis (TAK), but no specific biomarkers for VC associated with TAK have been identified, the relationship between VC and disease prognosis remains unclear. This study aimed to investigate potential factors associated with VC in TAK, with a focus on Fatty acid-binding protein 3 (FABP3), and to evaluate the relationship between VC and angiographic outcomes, as well as the role of FABP3 in this process.

TAK patients from a prospective observational cohort with or without VC confirmed by non-contrast CT, CTA or PET-CT were enrolled. Baseline plasma FABP3 levels were measured by ELISA. Analyses were adjusted for confounders using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Angiographic progression was defined in accordance with our previous reports.

A total of 210 patients were enrolled, of whom 57.1% (120/210) had VC. VC in TAK was significantly associated with age, longer disease duration, and elevated plasma FABP3 levels. After IPTW adjustment for BMI, disease duration, hypertension, age, sex, TG, and TNF-α, the high FABP3 group (FABP3≥ 0.6ng/mL) had a significantly higher risk of VC compared with the low FABP3 group (OR 4.48, 95% CI 1.58–12.75, p=0.01). After PSM based on age, sex, disease duration, and hypertension, plasma FABP3 level was also independently associated with VC (OR 4.4, 95%CI 1.5-12.9, p=0.01). Among 152 patients with available imaging follow-up, angiographic progression was noted in 30 patients (19.7%) during 36 (21-60) months. Cox regression revealed VC was an independent risk factor for angiographic progression (HR 2.79, 95% CI 1.10-7.32, p=0.04), as did the combination of VC and FABP3>0.6ng/mL (HR 3.17, 95% CI 1.17-8.58, p=0.02). Among the patients after PSM, 18 (18/70, 25.7%) showed angiographic progression, VC remained as an independent predictor of angiographic progression (HR 3.34, 95% CI 1.15-9.68, p=0.02), the combination of plasma FABP3>0.6ng/mL and VC further increased the HR to 4.55 (95% CI 1.66-12.48, p=0.00).

VC is a common complication of TAK, plasma FABP3 level was independently associated with VC associated with TAK. VC was an independent risk factor for angiographic progression in TAK; Furthermore, among patients with VC, elevated baseline FABP3 levels (FABP3>0.6ng/mL) further increased the risk of angiographic progression.