Influence of Traditional Risk Factors of Atherosclerosis in the Development of Severe Ischemic Complications in Giant Cell Arteritis

Abstract

Because the prognosis of giant cell arteritis (GCA) is related to the development of ischemic complications, we sought to assess the possible influence of traditional risk factors of atherosclerosis in the development of severe ischemic complications of GCA. We conducted a retrospective study of patients with biopsy-proven GCA diagnosed from 1981 to 2001 at the single hospital for a well-defined population of almost 250,000 people. Patients were considered to have severe ischemic manifestations if they suffered visual manifestations, cerebrovascular accidents, jaw claudication, or signs of occlusive changes in large arteries of the extremities. Patients were assessed for the presence of hypercholesterolemia, hypertension, diabetes mellitus, and heavy smoking at the time of GCA diagnosis. The presence of traditional risk factors of atherosclerosis at the time of GCA diagnosis in this series of 210 patients increased significantly the risk of developing at least 1 of the severe ischemic complications (odds ratio [OR], 1.79; 95% confidence intervals [CI], 1.03-3.11; p = 0.04). Patients with traditional atherosclerosis risk factors had fever less commonly than the rest of GCA patients (5.2% vs. 16.0%; p = 0.01). GCA patients with hypertension exhibited a significantly increased risk of developing severe ischemic complications (OR, 1.80; 95% CI, 1.00-3.25; p = 0.05). The current study suggests that the presence of atherosclerosis risk factors at the time of diagnosis of GCA may influence the development of severe ischemic manifestations of the disease.

Epidemiology of giant cell arteritis and polymyalgia rheumatica

“…Based on a series of 210 biopsy-proven GCA patients assessed for the risk of severe ischemic complications, we observed that the presence of traditional risk factors of atherosclerosis before the diagnosis of this vasculitis, in particular a history of hypertension, significantly increased the risk of developing severe ischemic complications of GCA (69). Also, patients with traditional atherosclerosis risk factors were found to have fever less commonly than those without classic atherosclerosis risk factors (69).…”

“…It is possible that, due to a severe and maintained inflammatory response, fever might represent the clinical expression of an angiogenic activity, which might play a compensatory role for ischemia in patients with GCA. According to that, GCA patients with atherosclerosis would be unable to establish appropriate angiogenic compensatory mechanisms and, due to this, they might have more vascular ischemic complications (69).…”

An atypical presentation of giant cell arteritis

“…In patients with giant cell arteritis, 50%-75% of strokes occur in the vertebrobasilar circulation (compared with 15%-20% of strokes in patients without giant cell arteritis). 6,10 Our patient developed bilateral occlusion of the vertebral arteries, which was confirmed by cerebral angiography. This occurs in only 0.1%-0.2% of patients with cerebrovascular disease.…”

PlA1/A2 polymorphism of the platelet glycoprotein receptor IIIA and risk of cranial ischemic complications in giant cell arteritis

“…Gonzalez-Gay et al (24) found that the presence of risk factors for atherosclerosis at the time of GCA diagnosis significantly increased the risk of developing at least one of the severe ischemic complications of the disease. Two case-control studies have shown an increased risk of GCA in heavy smokers and in patients with previous atherosclerotic disease (cardiovascular or peripheral vascular disease) (25,26).…”