Increased risk of cardiovascular disease in giant cell arteritis: a general population–based study

Amiri, Nasrin; Vera, Mary A. De; Choi, Hyon K.; Sayre, Eric C.; Aviña‐Zubieta, J Antonio

doi:10.1093/rheumatology/kev262

Cited by 64 publications

(44 citation statements)

References 39 publications

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“…These results are similar to those of previously reported increased rates of stroke, myocardial infarction, and peripheral vascular disease among patients with GCA in a large UKbased population (13). This study showed quite similar results to those in the recently published data from Amiri et al on the rate of ischemic heart diseases and CVA among patients with GCA (14). However, the rate ratios compared with reference population were higher in the Canadian study.…”

Section: Discussionsupporting

confidence: 91%

“…Udayakumar et al demonstrated no overall increased in the rate of acute coronary syndrome among patients with GCA (15). The association between GCA and coronary artery disease is unclear with varied findings among several population-based studies (13)(14)(15). Differences in case ascertainment of cases of GCA (study criteria vs. biopsy-proven GCA) may explain such variations.…”

Section: Discussionmentioning

confidence: 99%

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Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study

et al. 2016

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Objective.To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.Methods.The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skåne Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated.Results.There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33–3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61–3.40), severe infections (1.85, 95% CI 1.57–2.18), thyroid diseases (1.55, 95% CI 1.25–1.91), cerebrovascular accidents (1.40, 95% CI 1.12–1.74), and diabetes mellitus (1.29, 95% CI 1.05–1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00–1.44).Conclusion.Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study

et al. 2016

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“…For the incidence of GCA-related stroke, the models assume that 2.64% of cases of GCA result in a stroke, as per Amiri et al, 90 and further assume that strokes arise after presentation to the patient's GP. It is also assumed that stroke occurring as a result of GCA has the same severity and likelihood of fatality as stroke unrelated to GCA.…”

Section: Strokementioning

confidence: 99%

“…20 NO. 90 and quality of life (e.g. through reduced incidence of blindness or reduced incidence of fractures).…”

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confidence: 99%

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

364

404

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Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

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“…Based on retrospective studies, GCA is associated with an increased prevalence of traditional cardiovascular (CV) risk factors and CV events, including myocardial infarction and stroke 1,2,3,4,5 . However, studies regarding management of CV disease (CVD) in GCA are lacking.…”

Section: To the Editormentioning

confidence: 99%

Cardiovascular Risk Prevention in a Canadian Population of Patients with Giant Cell Arteritis

Yeung

Barra

2017

J Rheumatol

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Increased risk of cardiovascular disease in giant cell arteritis: a general population–based study

Abstract: These findings provide general population-based evidence that GCA patients are at a substantially increased risk of cardiovascular disease. Increased monitoring for this potentially fatal outcome and its modifiable risk factors is warranted for GCA patients.

Cited by 64 publications

References 39 publications

Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study

Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Cardiovascular Risk Prevention in a Canadian Population of Patients with Giant Cell Arteritis

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