Negative associations for fasting blood glucose, cholesterol and triglyceride levels with the development of giant cell arteritis

Abstract

Objectives To investigate metabolic features that may predispose to GCA in a nested case–control study. Methods Individuals who developed GCA after inclusion in a population-based health survey (the Malmö Preventive Medicine Project; N = 33 346) were identified and validated through a structured review of medical records. Four controls for every validated case were selected from the database. Results A total of 76 cases with a confirmed incident diagnosis of GCA (61% female, 65% biopsy positive, mean age at diagnosis 70 years) were identified. The median time from screening to diagnosis was 20.7 years (range 3.0–32.1). Cases had significantly lower fasting blood glucose (FBG) at baseline screening compared with controls [mean 4.7 vs 5.1 mmol/l (s.d. overall 1.5), odds ratio (OR) 0.35 per mmol/l (95% CI 0.17, 0.71)] and the association remained significant when adjusted for smoking [OR 0.33 per mmol/l (95% CI 0.16, 0.68)]. Current smokers had a reduced risk of GCA [OR 0.35 (95% CI 0.18, 0.70)]. Both cholesterol [mean 5.6 vs 6.0 mmol/l (s.d. overall 1.0)] and triglyceride levels [median 1.0 vs 1.2 mmol/l (s.d. overall 0.8)] were lower among the cases at baseline screening, with significant negative associations with subsequent GCA in crude and smoking-adjusted models [OR 0.62 per mmol/l (95% CI 0.43, 0.90) for cholesterol; 0.46 per mmol/l (95% CI 0.27, 0.81) for triglycerides]. Conclusion Development of GCA was associated with lower FBG and lower cholesterol and triglyceride levels at baseline, all adjusted for current smoking, suggesting that metabolic features predispose to GCA.

Cellular Signaling Pathways in Medium and Large Vessel Vasculitis

“…PD-L1 expression is dependent on glucose uptake and intracellular glycolytic activity (66,91,92). Large epidemiological studies demonstrate that body mass index and fasting blood glucose levels were negatively associated with the development of GCA (93,94), supporting the concept that low glycolytic activity promotes low PD-L1 expression, enabling uncontrolled autoimmunity.…”

Cardiovascular drug treatment, statins and biopsy-confirmed giant cell arteritis: a population-based case–control study

“…23 Wadström et al have also recently suggested a negative association between the levels of cholesterol and triglycerides with the subsequent occurrence of GCA in a population-based cohort. 24 Accordingly, the impact of statins on the occurrence of GCA in our study is most probably mediated through its anti-inflammatory effect rather than cholesterol-lowering effect. Our results suggest that statin users exhibit consistently lower incidence of developing GCA compared with their controls, supported by analysis of both any drug use and new drug use, and the dose-response pattern.…”

“… 23 Wadström et al have also recently suggested a negative association between the levels of cholesterol and triglycerides with the subsequent occurrence of GCA in a population-based cohort. 24 Accordingly, the impact of statins on the occurrence of GCA in our study is most probably mediated through its anti-inflammatory effect rather than cholesterol-lowering effect.…”

Global epidemiology of vasculitis

“…The aetiology of GCA is poorly understood, but associations with host and environmental factors have been investigated. Obesity and diabetes mellitus are negatively associated with GCA 43 – 45 , whereas exposure to different infections, particularly those that affect the respiratory system, is associated with an increased risk of GCA 46 , 47 . Studies on smoking have shown variable effects that range from a protective effect on GCA development in men to an association with increased risk of GCA in women 48 , 49 .…”