Cardiovascular drug treatment, statins and biopsy-confirmed giant cell arteritis: a population-based case–control study

Turkiewicz, Aleksandra; Stamatis, Pavlos; Mohammad, Aladdin J

doi:10.1136/rmdopen-2020-001285

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…Medications that can be “thrombogenic” include diuretics that may cause hemoconcentration and lead to increased blood viscosity via changes in fibrinogen concentrations and coagulation time ( 15 ). Of note a recent study demonstrated that diuretic use might be weakly associated with a lower risk of GCA ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Predictive models for thromboembolic events in giant cell arteritis: A US veterans health administration population-based study

Michailidou

Zhang

Kuderer³

et al. 2022

Front. Immunol.

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Giant cell arteritis (GCA) that affects older patients is an independent risk factor for thromboembolic events. The objective of this study was to identify predictive factors for thromboembolic events in patients with GCA and develop quantitative predictive tools (prognostic nomograms) for pulmonary embolism (PE) and deep venous thrombosis (DVT). A total of 13,029 patients with a GCA diagnosis were included in this retrospective study. We investigated potential predictors of PE and DVT using univariable and multivariable Cox regression models. Nomograms were then constructed based on the results of our Cox models. We also assessed the accuracy and predictive ability of our models by using calibration curves and cross-validation concordance index. Age, inpatient status at the time of initial diagnosis of GCA, number of admissions before diagnosis of GCA, and Charlson comorbidity index were each found to be independent predictive factors of thromboembolic events. Prognostic nomograms were then prepared based on these predictors with promising prognostic ability. The probability of developing thromboembolic events over an observation period of 5 years was estimated by with time-to-event analysis using the method of Kaplan and Meier, after stratifying patients based on predicted risk. The concordance index of the time-to-event analysis for both PE and DVT was > 0.61, indicating a good predictive performance. The proposed nomograms, based on specific predictive factors, can accurately estimate the probability of developing PE or DVT among patients with GCA.

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Section: Introductionmentioning

confidence: 99%

Predictive models for thromboembolic events in giant cell arteritis: A US veterans health administration population-based study

Michailidou

Zhang

Kuderer³

et al. 2022

Front. Immunol.

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All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study

et al. 2021

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Objectives To investigate whether giant cell arteritis (GCA) is associated with increased all-cause and cause-specific mortality. Methods A nationwide, population-based cohort study in Denmark using medical and administrative registries. GCA cases were defined as patients aged ≥50 years from 1996-2018 with a first-time discharge diagnosis of GCA and ≥3 prescriptions for prednisolone within 6 months following diagnosis. Each GCA patient was matched based on age, sex and calendar time to 10 persons without a history of GCA. Index date was the date for the third prednisolone prescription. We used a pseudo-observation approach to calculate all-cause and cause-specific mortality, adjusted risk differences (RDs) and relative risks (RRs). Results We included 9908 GCA patients and 98204 persons from the general population. The median time for GCA patients to redeem the third prednisolone prescription was 74 days (IQR: 49-106). Among GCA patients, the overall mortality was 6.4% (95% CI: 5.9-6.9) 1 year after index date and 45% (95% CI: 44-47) after 10 years. Compared to the reference cohort, adjusted RDs and RRs of deaths in the GCA cohort were 2.2% (95% CI: 1.7-2.7) and 1.49 (95% CI: 1.36-1.64) after 1 year, and 2.1% (95% CI: 1.0-3.3) and 1.03 (95% CI: 1.00-1.05) 10 years after index date. GCA patients had a higher risk of death due to infectious, endocrine, cardiovascular, and gastrointestinal diseases. Conclusions GCA is associated with increased all-cause mortality, particularly within the first year following the diagnosis. Cause-specific mortality indicates that mortality in GCA may in part be due to glucocorticoid-related complications.

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Angiotensin receptor blockade is associated with increased risk of giant cell arteritis

et al. 2022

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Objectives Angiotensin II is implicated in giant cell arteritis (GCA) pathology. We examined whether the use of angiotensin receptor blockers (ARB) is associated with GCA risk, compared with ACE inhibitors (ACEi) or other antihypertensives. Methods We performed a matched cohort study including adults who were initiators of antihypertensives in UK primary care data between 1995 and 2019. Treatment naïve individuals without prior GCA or polymyalgia rheumatica (PMR) were categorised into three groups—ARB initiators, ACEi initiators, or other antihypertensive initiators (beta-blockers, calcium channel blockers, diuretics or alpha-adrenoceptor blockers) – and followed for up to 5 years. Incident GCA was defined using validated Read codes, with age of onset ≥50 years and ≥2 glucocorticoid prescriptions. Inverse-probability-weighted Cox models were used to model outcome risk, adjusting for lifestyle parameters, comorbidities, and comedications. Results Among over a million new starters of antihypertensives (81 780 ARB, 422 940 ACEi, and 873 066 other antihypertensives), the incidence rate of GCA per 10 000 patient-years was 2.73 (95%CI 2.12–3.50) in the ARB group, 1.76 (95%CI 1.25–2.39) in the ACEi group, and 1.90 (95%CI 1.37–2.56) in other antihypertensive group. The hazard of GCA was higher in ARB initiators (HR 1.55; 95%CI 1.16–2.06) than initiators of ACEi, but similar between initiators of other antihypertensives and ACEi (HR 1.08; 95%CI 0.87–1.35). Conclusions Initiation of ARB is associated with higher risk of GCA compared with ACEi or other antihypertensives. Mechanistic studies of angiotensin receptor biology will provide further clarity for our findings.

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Cardiovascular drug treatment, statins and biopsy-confirmed giant cell arteritis: a population-based case–control study

Cited by 4 publications

References 31 publications

Predictive models for thromboembolic events in giant cell arteritis: A US veterans health administration population-based study

Predictive models for thromboembolic events in giant cell arteritis: A US veterans health administration population-based study

All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study

Angiotensin receptor blockade is associated with increased risk of giant cell arteritis

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