Risk factors for symptomatic vascular events in giant cell arteritis: a study of 254 patients with large-vessel imaging at diagnosis

Abstract

Aims: To identify factors associated with vascular events in patients with giant cell arteritis (GCA). Methods: We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Symptomatic vascular events were defined as the occurrence of any aortic event (aortic dissection or symptomatic aortic aneurysm), stroke, myocardial infarction, limb or mesenteric ischemia and de novo lower limbs arteritis stage 3 or 4. Patients with symptomatic vascular event (VE+) and without were compared, and risk factors were identified in a multivariable analysis. Results: Thirty-nine (15.4%) of the 254 included patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were more frequent in VE+ patients ( p < 0.05), as an abnormal computed tomography (CT)-scan at diagnosis ( p = 0.04), aortitis ( p = 0.01), particularly of the descending thoracic aorta ( p = 0.03) and atheroma ( p = 0.03). Deaths were more frequent in the VE+ group (37.1 versus 10.3%, p = 0.0003). In multivariable analysis, aortic surgery [hazard ratio (HR): 10.46 (1.41–77.80), p = 0.02], stroke [HR: 22.32 (3.69–135.05), p < 0.001], upper limb ischemia [HR: 20.27 (2.05–200.12), p = 0.01], lower limb ischemia [HR: 76.57 (2.89–2027.69), p = 0.009], aortic atheroma [HR: 3.06 (1.06–8.82), p = 0.04] and aortitis of the descending thoracic aorta on CT-scan at diagnosis [HR: 4.64 (1.56–13.75), p = 0.006] were independent predictive factors of a vascular event. Conclusion: In this study on GCA cases with large vessels imaging at diagnosis, aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event. Plain language summary Risk factors for symptomatic vascular events in giant cell arteritis This study was performed to identify the risk factors for developing symptomatic vascular event during giant cell arteritis (GCA) because these are poorly known. We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Patients with symptomatic vascular event (VE+) and without (VE-) were compared, and risk factors were identified in a multivariable analysis. Thirty-nine patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were significantly more frequent in VE+ patients, as an abnormal CT-scan at diagnosis, aortitis, particularly of the descending thoracic aorta and atheroma. Deaths were more frequent in the VE+ group. Among 254 GCA patients, 39 experienced at least one vascular event during follow-up. Aortic surgery, stroke, upper and lower limb ischemia were vascular event risk factors. Aortic atheroma and descending thoracic aorta aortitis on CT-scan were vascular event risk factors. This study on GCA cases with large vessels imaging at diagnosis, showed that aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event.

NADPH oxidase subunit p22phox gene C242T polymorphism and vascular complications in diabetes: a color Doppler ultrasound study

“…Some studies have shown that the number of T2DM patients with cardiovascular disease is 2 to 4-fold higher than normal people (12)(13). Mornac (14) con rmed that macrovascular T2DM patients accounted for 59% of those who died due to T2DM vascular complications; this was 70-fold higher than the number of patients dying from microvascular disease. Clinically, the most common macrovascular complications of T2DM are the thickening of the carotid intima-media membrane and the formation of plaques, which lead to the proliferation of vascular endothelial smooth muscle, and eventually lead to a variety of atherosclerotic diseases, with death in severe cases.…”

Salivary gland 18F-FDG-PET/CT uptake patterns in Sjögren's syndrome and giant cell arteritis patients

“…Vasculitis activity may result in ischaemia due to reduced blood flow supply, because of reduced vascular diameters. Both GCA-induced inflammation and ischaemia can induce elevated 18 F-FDG-uptake (43,44). Medium sized arteries such as the facial artery tend to be involved in GCA (21,25).…”

An Updated Review of Cardiovascular Events in Giant Cell Arteritis

“…They also were the first to suggest that persisting aortic hypermetabolism might later favor the occurrence of aortic dilation [72]. Since then, many other cohort studies confirmed that GCA patients with LVV have a higher risk of developing an aortic dilation, mostly on the involved arterial segments, versus those without LVV [73][74][75][76]. Moreover, while aortic complications are often discovered between 5 and 10 years after GCA diagnosis [18,68], patients with LVV might develop aortic dilation or dissection earlier than those without [74,77].…”

“…Altogether, based on the previous studies showing the frequent development of a dilation mostly on the thoracic section of the aorta in patients with LVV [73][74][75][76], a regular monitoring of aorta caliber is required. Echocardiography may be a useful, cost-effective and non-irradiating tool to monitor the thoracic aorta caliber and detect any dilation.…”