Rheumatology Advance Access published online on December 24, 2008
Rheumatology, doi:10.1093/rheumatology/ken465
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Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis
1Unità Operativa di Reumatologia, 2Unità Operativa di Oculistica, 3Unità di Statistica, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Correspondence to:
C. Salvarani, Servizio di Reumatologia, Arcispedale S. Maria Nuova, V. le Risorgimento N80, 42100 Reggio Emilia, Italy. E-mail: salvarani.carlo{at}asmn.re.it
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Abstract |
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Objective. To evaluate the impact of traditional cardiovascular risk factors, carotid atherosclerosis and the effect of anti-platelet/anti-coagulant therapy on the occurrence of severe cranial ischaemic events (CIEs) in GCA.
Methods. We identified 180 Reggio Emilia (Italy) residents with biopsy-proven GCA diagnosed between 1986 and 2005. We evaluated data on demographics, clinical features, laboratory investigations, cardiovascular risk factors, anti-platelet/anti-coagulant use and carotid atherosclerosis.
Results. Systemic signs/symptoms were significantly less frequent (P = 0.004) and ESR and C-reactive protein (CRP) values at diagnosis were significantly lower (P = 0.03 and P = 0.04, respectively) in patients with CIEs. The prevalence of hypertension and ischaemic heart disease was significantly higher in patients with CIEs than in those without (P = 0.01 and P = 0.006, respectively). Patients treated with anti-platelet/anti-coagulant therapy were significantly more likely to suffer CIEs than those without (P = 0.03), while CIEs were significantly associated with ischaemic heart disease in this subset of patients (P = 0.02). By multivariate logistic regression, we found that the best predictors for the development of severe CIEs included the absence of high (>5.38 mg/dl) CRP levels at diagnosis (OR = 0.31, 95% CI 0.08, 1.20), the absence of systemic manifestations (OR = 0.30, 95% CI 0.08, 1.08), the presence of hypertension (OR = 7.77, 95% CI 0.83, 72.76), and a past history of ischaemic heart disease (OR = 8.65, 95% CI 0.92, 80.95).
Conclusions. In GCA, hypertension, a past history of ischaemic heart disease and a low inflammatory response are associated with a higher risk of developing severe CIEs.
KEY WORDS: Giant cell arteritis, Cranial ischaemic events, Cardiovascular risk factors, Carotid atherosclerosis, Population-based study
Submitted 25 July 2008;
revised version accepted 19 November 2008.
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  O. Steichen Comment on: Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis Rheumatology, September 1, 2009; 48(9): 1180 - 1180. [Full Text] [PDF]
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