The relative risk of aortic aneurysm in patients with giant cell arteritis compared with the general population of the UK

Abstract

ObjectivesTo evaluate the risk of aortic aneurysm in patients with giant cell arteritis (GCA) compared with age-, gender- and location-matched controls.MethodsA UK General Practice Research Database (GPRD) parallel cohort study of 6999 patients with GCA and 41 994 controls, matched on location, age and gender, was carried out. A competing risk model using aortic aneurysm as the primary outcome and non-aortic-aneurysm-related death as the competing risk was used to determine the relative risk (subhazard ratio) between non-GCA and GCA subjects, after adjustment for cardiovascular risk factors.ResultsComparing the GCA cohort with the non-GCA cohort, the adjusted subhazard ratio (95% CI) for aortic aneurysm was 1.92 (1.52 to 2.41). Significant predictors of aortic aneurysm were being an ex-smoker (2.64 (2.03 to 3.43)) or a current smoker (3.37 (2.61 to 4.37)), previously taking antihypertensive drugs (1.57 (1.23 to 2.01)) and a history of diabetes (0.32 (0.19 to 0.56)) or cardiovascular disease (1.98 (1.50 to 2.63)). In a multivariate model of the GCA cohort, male gender (2.10 (1.38 to 3.19)), ex-smoker (2.20 (1.22 to 3.98)), current smoker (3.79 (2.20 to 6.53)), previous antihypertensive drugs (1.62 (1.00 to 2.61)) and diabetes (0.19 (0.05 to 0.77)) were significant predictors of aortic aneurysm.ConclusionsPatients with GCA have a twofold increased risk of aortic aneurysm, and this should be considered within the range of other risk factors including male gender, age and smoking. A separate screening programme is not indicated. The protective effect of diabetes in the development of aortic aneurysms in patients with GCA is also demonstrated.

Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update

“…However, this condition is under-diagnosed, as symptoms are frequently mild, non-specific, and insidious. It is estimated that GCA patients have a 2-fold increased risk of aortic aneurysm 24. Symptoms suggestive of involvement of the coronary, mesenteric, and lower extremity arteries are rare.…”

The risk of deep venous thrombosis and pulmonary embolism in giant cell arteritis: a general population-based study

“…GCA, the most frequent form of vasculitis in adults,1 is associated with significant morbidity due to vascular problems. For example, studies have found that GCA is associated with arterial complications like blindness,2 aortic aneurysms,3 myocardial infarction4–6 and ischaemic stroke 6–8. These previous studies have focused on arterial events, with the risk of venous thromboembolism (VTE) events in patients with GCA being largely ignored despite an array of plausible mechanisms 9 10…”

Giant cell arteritis as unusual cause of critical arm ischemia

“…Patients with GCA have a twofold increased risk of aortic aneurysm, 11 and imaging of the aorta is required in all patients at the time of diagnosis. If the aorta is involved in the inflammatory process, periodic imaging surveillance is mandatory because aortic expansion may occur with the risk of late rupture and dissection 12 …”