Statin Use in Giant Cell Arteritis: A Retrospective Study

Schmidt, J.; Kermani, Tanaz A.; Muratore, Francesco; Crowson, Cynthia S.; Matteson, Eric L.; Warrington, Kenneth J.

doi:10.3899/jrheum.121150

Cited by 48 publications

(25 citation statements)

References 31 publications

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“…The proportion of GCA patients who experienced at least one episode of UTI, URTI or serious infections was 48% which is significantly higher than the previously reported infection rates in GCA (4, 8, 10). Diabetes mellitus was present more common in GCA cohort in the UK study which is in contrary to other GCA cohorts including ours (11-13). In contrast to our study, the individual medical records were not reviewed in the UK study; hence there may be a greater possibility for misclassification of GCA and/or infections in the UK study.…”

Section: Discussioncontrasting

confidence: 97%

Hospitalized Infections in Giant Cell Arteritis — A Population-based Retrospective Cohort Study

Udayakumar

Chandran²,

Crowson³

et al. 2014

J Rheumatol

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Objective We aimed to assess the occurrence of infections requiring or acquired during hospitalizations in patients with giant cell arteritis (GCA). Methods We retrospectively reviewed a population-based incidence cohort of GCA patients diagnosed between 1950 and 2009 and compared this cohort with age, sex and calendar year matched cohort from the same population. Results We identified 245 patients in the GCA cohort and 245 patients in the non-GCA cohort. 74 GCA (134 episodes) and 79 non-GCA (153 episodes) subjects had infections requiring, or acquired during hospitalizations [Rate ratio (RR) 0.94; 95% confidence interval (CI) 0.74, 1.18]. 67 subjects (107 episodes) in GCA cohort and 63 subjects (110 episodes) in non-GCA cohort required hospitalization secondary to an infection [RR 1.04; CI (0.80, 1.36)]. Pneumonia, urinary tract infections, skin and soft tissue infections accounted for the majority of infections requiring hospitalizations and had similar occurrence in both cohorts. Urinary tract infections accounted for the majority of infections requiring hospitalization in the first 6 months after GCA incidence [RR 3.93; CI (0.85, 56.52)]. No difference between the two cohorts was noted in overall infections acquired during hospitalizations [RR 0.68; CI (0.41, 1.08)]. Conclusion There is no overall increased risk of infections requiring or acquired during hospitalizations in patients with giant cell arteritis on glucocorticoid therapy. There may be an increased risk of infections requiring hospitalization, especially of the urinary tract in the first six months after GCA incidence although this did not achieve statistical significance in our study.

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Section: Discussioncontrasting

confidence: 97%

Hospitalized Infections in Giant Cell Arteritis — A Population-based Retrospective Cohort Study

Udayakumar

Chandran²,

Crowson³

et al. 2014

J Rheumatol

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“…These results may reflect the findings of several recent studies which determined that patients with GCA had lower rates of cardiovascular risk factors than population-based controls at the time of diagnosis [17–19]. These factors include smoking, hypertension, diabetes mellitus, a history of myocardial infarction, and obesity.…”

Section: 1 Discussionsupporting

confidence: 80%

Hospitalization rates and utilization among patients with giant cell arteritis: A population-based study from 1987 to 2012

Michet

Achenbach

Crowson

et al. 2015

Seminars in Arthritis and Rheumatism

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BACKGROUND Patients with giant cell arteritis (GCA) may experience serious vascular and visual complications. It is unknown, however, to what extent the difficulties of the disease may lead to hospitalization. The goal of this study is to discern whether patients with GCA are at greater risk for all-cause hospitalizations when compared to the general population. METHODS This retrospective, population-based cohort study utilized patients with large vessel or visual involvement who were diagnosed with GCA (as defined by the 1990 ACR criteria) between 1/1/1950 and 12/31/2009, and a reference cohort of patients without GCA matched on age, sex, and calendar year. Each patient’s medical record was examined for hospitalizations from 1987 through 2012. For this analysis, follow-up began with the latter of index date or 1/1/1987 and ended at the earlier of death, emigration from Olmsted County, or 12/31/2012. Discharge diagnoses were grouped together using the Clinical Classifications Software (CCS) for ICD-9-CM from Healthcare Cost and Utilization Project (HCUP). Data were analyzed using person-year methods and rate ratios comparing GCA to non-GCA. RESULTS The GCA cohort consists of 199 patients with a mean age of 76.2 (79.9% female) and follow-up of 8.2 years. The non-GCA cohort is comprised of 194 patients with a mean age of 75.7 (78.9% female) and follow-up of 8.6 years. The patients with GCA had 816 hospitalizations and the non-GCA patients had 737 hospitalizations. GCA patients proved to be at a marginally greater risk for all causes of hospitalization (Rate Ratio [RR] 1.13, 95% Confidence Interval [CI] 1.02, 1.25); however, the rate of hospitalization for patients with and without GCA decreased significantly from 1987 to 2012. Two specific discharge categories are of interest. First, transient cerebral ischemia is a greater risk of hospitalization for patients with GCA who had 16 hospitalizations compared to patients without GCA who only had 5 hospitalizations (RR 3.06, CI 1.27, 9.47). Second, patients with GCA (21 hospitalizations) are at greater risk of hospitalization for syncope than patients without GCA (5 hospitalizations) (RR 3.98, CI 1.72, 12.14). CONCLUSION In this first ever analysis of all-cause hospitalizations in a population-based cohort, patients with GCA appear to be at a marginally greater risk for hospitalization than patients without GCA, although the rate of hospitalization for GCA patients decreased from 1987 to 2012. Patients with GCA are at increased risk of hospitalization for both transient cerebral ischemia and syncope.

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“…Lower numbers of subjects in the GCA cohort were on antihypertensives (not statistically significant) and lipid-lowering medications at the index date. The lower prevalence of diabetes is also noted in other GCA cohorts (14-16). In all these cohorts less than 10% of the biopsy-positive GCA patients had diabetes at the time of biopsy.…”

Section: Discussionsupporting

confidence: 60%

Cardiovascular Risk and Acute Coronary Syndrome in Giant Cell Arteritis: A Population‐Based Retrospective Cohort Study

Udayakumar

Chandran

Crowson

et al. 2015

Arthritis Care & Research

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Objective We assessed the occurrence of acute coronary syndrome (ACS) in patients with giant cell arteritis (GCA) compared to subjects without GCA. Methods We retrospectively reviewed a population-based incidence cohort of Olmsted County, Minnesota residents with GCA diagnosed in 1950-2009. We compared this cohort with a cohort of patients without GCA of similar age, sex and calendar year from the same population. Results The study included 245 patients with GCA and 245 non-GCA subjects. Mean Framingham cardiovascular risk score was 30% (SD 19%) in GCA and 34% (SD 23%) in non-GCA (p=0.096) at incidence/index date. Diabetes mellitus was significantly less common in GCA than non-GCA at index date. Mean high-density lipoprotein was higher and triglycerides were lower and fewer patients were using lipid-lowering medications in the GCA cohort compared to the non-GCA at index date. During follow-up, no difference between the two cohorts was noted in overall rate of ACS events [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.44, 1.26]. Overall thrombosis in myocardial infarction (TIMI) scores were similar in both cohorts. Revascularization procedures were done less frequently in GCA than non-GCA subjects (19% vs. 50%; p=0.015). Post ACS hospital length of stays and complications were similar in both cohorts. Conclusion Multiple cardiovascular risk factors are more favorable at incidence of GCA. There is no overall increased risk of acute coronary syndromes in patients with GCA.

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Statin Use in Giant Cell Arteritis: A Retrospective Study

Cited by 48 publications

References 31 publications

Hospitalized Infections in Giant Cell Arteritis — A Population-based Retrospective Cohort Study

Hospitalized Infections in Giant Cell Arteritis — A Population-based Retrospective Cohort Study

Hospitalization rates and utilization among patients with giant cell arteritis: A population-based study from 1987 to 2012

Cardiovascular Risk and Acute Coronary Syndrome in Giant Cell Arteritis: A Population‐Based Retrospective Cohort Study

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