Watch for CV Disease With GCA -- Especially Just After Diagnosis

January 27, 2014

Giant-cell arteritis (GCA) is associated with increased risks for myocardial infarction, stroke, and peripheral vascular disease, a cohort study finds, and especially so immediately after diagnosis.

Risk for Cardiovascular Disease Early and Late After a Diagnosis of Giant-Cell Arteritis: A Cohort StudyAnnals of Internal Medicine, Jan. 21, 2014

Giant-cell arteritis (GCA) is associated with increased risks for myocardial infarction (MI), cerebrovascular accident (CVA), and peripheral vascular disease (PVD), according to a prospective observational cohort study. The relative risk for cardiovascular disease is especially high immediately after diagnosis of GCA.

The hazard ratios were 2 for MI, 1.3 for CVA, and 2 for PVD.

The study followed 3,408 patients with incident GCA for a median four years, comparing them to 17,027 matched patients without GCA from the UK primary care database of 7.3 million patients. Previous studies have been smaller and conflicting. This study matched the two groups for smoking status, hypertension, cholesterol, diabetes mellitus, and body mass index. Some data, such as the actual GCA biopsy results, was missing and had to be inferred from other data on the patient record.

The association of GCA with cardiovascular disease was stronger soon after the diagnosis of GCA. The hazard ratios were 5 at 1 month after diagnosis, compared to 1.7 during the entire followup period.

This could be due to the proatherosclerotic effects of glucorticoids, the interruption of anticoagulation agents required for temporal artery biopsy, or the psychological stress associated with fear of blindness.