Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis

Rheumatology (Oxford). 2009 Mar;48(3):250-3. doi: 10.1093/rheumatology/ken465. Epub 2008 Dec 24.


Objective: To evaluate the impact of traditional cardiovascular risk factors, carotid atherosclerosis and the effect of anti-platelet/anti-coagulant therapy on the occurrence of severe cranial ischaemic events (CIEs) in GCA.

Methods: We identified 180 Reggio Emilia (Italy) residents with biopsy-proven GCA diagnosed between 1986 and 2005. We evaluated data on demographics, clinical features, laboratory investigations, cardiovascular risk factors, anti-platelet/anti-coagulant use and carotid atherosclerosis.

Results: Systemic signs/symptoms were significantly less frequent (P = 0.004) and ESR and C-reactive protein (CRP) values at diagnosis were significantly lower (P = 0.03 and P = 0.04, respectively) in patients with CIEs. The prevalence of hypertension and ischaemic heart disease was significantly higher in patients with CIEs than in those without (P = 0.01 and P = 0.006, respectively). Patients treated with anti-platelet/anti-coagulant therapy were significantly more likely to suffer CIEs than those without (P = 0.03), while CIEs were significantly associated with ischaemic heart disease in this subset of patients (P = 0.02). By multivariate logistic regression, we found that the best predictors for the development of severe CIEs included the absence of high (>5.38 mg/dl) CRP levels at diagnosis (OR = 0.31, 95% CI 0.08, 1.20), the absence of systemic manifestations (OR = 0.30, 95% CI 0.08, 1.08), the presence of hypertension (OR = 7.77, 95% CI 0.83, 72.76), and a past history of ischaemic heart disease (OR = 8.65, 95% CI 0.92, 80.95).

Conclusions: In GCA, hypertension, a past history of ischaemic heart disease and a low inflammatory response are associated with a higher risk of developing severe CIEs.

MeSH terms

  • Aged
  • Anticoagulants / adverse effects
  • Biomarkers / blood
  • Brain Ischemia / etiology*
  • C-Reactive Protein / analysis
  • Carotid Artery Diseases / complications
  • Female
  • Giant Cell Arteritis / complications*
  • Humans
  • Hypertension / complications
  • Male
  • Myocardial Ischemia / complications
  • Platelet Aggregation Inhibitors / adverse effects
  • Risk Factors


  • Anticoagulants
  • Biomarkers
  • Platelet Aggregation Inhibitors
  • C-Reactive Protein