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Original Research |

Risk for Cardiovascular Disease Early and Late After a Diagnosis of Giant-Cell Arteritis: A Cohort Study

Gunnar Tomasson, MD; Christine Peloquin, MPH; Aladdin Mohammad, MD, PhD; Thorvardur J. Love, MD, PhD; Yuqing Zhang, DSc; Hyon K. Choi, MD, DrPH; and Peter A. Merkel, MD, MPH
[+] Article and Author Information

From University of Iceland, Reykjavik, Iceland; Boston University School of Medicine and Boston University School of Public Health, Boston, Massachusetts; Skåne University Hospital, Lund, Sweden; and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Grant Support: This work was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60 AR047785) and the Boston University School of Medicine.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3046.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Tomasson (e-mail, gunnar.tomasson@gmail.com).

Requests for Single Reprints: Gunnar Tomasson, MD, Department of Public Health Sciences, University of Iceland, Stapi Hringbraut, 101 Reykjavik, Iceland; e-mail, gunnar.tomasson@gmail.com.

Current Author Addresses: Dr. Tomasson: Department of Public Health Sciences, University of Iceland, Stapi Hringbraut, 101 Reykjavik, Iceland.

Ms. Peloquin and Drs. Zhang and Choi: Boston University, 650 Albany Street, Suite 200, Boston, MA 02118.

Dr. Mohammad: Department of Rheumatology, Skåne University Hospital, Lund SE-221 85, Sweden.

Dr. Love: Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland.

Dr. Merkel: University of Pennsylvania, 8th Floor Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104.

Author Contributions: Conception and design: G. Tomasson, T.J. Love, Y. Zhang, H.K. Choi, P.A. Merkel.

Analysis and interpretation of the data: G. Tomasson, A. Mohammad, Y. Zhang, H.K. Choi, P.A. Merkel.

Drafting of the article: G. Tomasson, Y. Zhang, H.K. Choi, P.A. Merkel.

Critical revision of the article for important intellectual content: G. Tomasson, T.J. Love, Y. Zhang, H.K. Choi, P.A. Merkel.

Final approval of the article: G. Tomasson, A. Mohammad, T.J. Love, Y. Zhang, H.K. Choi, P.A. Merkel.

Statistical expertise: G. Tomasson, Y. Zhang, H.K. Choi.

Obtaining of funding: H.K. Choi.

Administrative, technical, or logistic support: G. Tomasson, H.K. Choi, P.A. Merkel.

Collection and assembly of data: C. Peloquin, H.K. Choi.


Ann Intern Med. 2014;160(2):73-80. doi:10.7326/M12-3046
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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.

Figures

Grahic Jump Location
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.

Grahic Jump Location

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Summary for Patients

Heart Attacks, Strokes, and Peripheral Artery Disease in Patients With Giant-Cell Arteritis

The full report is titled “Risk for Cardiovascular Disease Early and Late After a Diagnosis of Giant-Cell Arteritis. A Cohort Study.” It is in the 21 January 2014 issue of Annals of Internal Medicine (volume 160, pages 73-80). The authors are G. Tomasson, C. Peloquin, A. Mohammad, T.J. Love, Y. Zhang, H.K. Choi, and P.A. Merkel.

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