Risk for cardiovascular disease early and late after a diagnosis of giant-cell arteritis: a cohort study

Abstract

Background: Involvement of large arteries is well-documented in giant-cell arteritis (GCA), but the risk for cardiovascular events is not well-understood.

Objective: To evaluate the risks for incident myocardial infarction (MI), cerebrovascular accident (CVA), and peripheral vascular disease (PVD) in individuals with incident GCA in a general population context.

Design: Observational cohort study.

Setting: U.K. primary care database.

Patients: 3408 patients with incident GCA and 17 027 age- and sex-matched reference participants without baseline cardiovascular disease (MI, CVA, or PVD).

Measurements: Diagnoses of GCA, outcomes, and cardiovascular risk factors were identified from electronic medical records. One combined and 3 separate cohort analyses were conducted for the outcomes of MI, CVA, and PVD. The association of GCA with study outcomes is expressed with hazard ratios (HRs) with 95% CIs after adjustment for potential cardiovascular risk factors.

Results: Among 3408 patients with GCA (73% female; mean age, 73 years), the incidence rates of MI, CVA, and PVD were 10.0, 8.0, and 4.2 events per 1000 person-years, respectively, versus 4.9, 6.3, and 2.0 events per 1000 person-years, respectively, among reference participants. The HRs were 1.70 (95% CI, 1.51 to 1.91) for the combined outcome, 2.06 (CI, 1.72 to 2.46) for MI, 1.28 (CI, 1.06 to 1.54) for CVA, and 2.13 (CI, 1.61 to 2.81) for PVD. The HRs were more pronounced in the first month after GCA diagnosis (combined HR, 4.92 [CI, 2.59 to 9.34]; HR for MI, 11.89 [CI, 2.40 to 59.00]; HR for CVA, 3.93 [CI, 1.76 to 8.79]; HR for PVD, 3.86 [CI, 0.78 to 19.17]).

Limitation: Information on temporal arterial biopsies was not available, and there was a substantial amount of missing data on cardiovascular risk factors.

Conclusion: Giant-cell arteritis is associated with increased risks for MI, CVA, and PVD.

Primary funding source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Figure

Cumulative incidence in the 3408 patients with incident GCA and age-, sex-, and entry time–matched reference participants. Because patients were censored when they sustained the competing event, the number “at risk” at each time is identical for the 4 outcomes. GCA = giant-cell arteritis.