Session Information
Date: Sunday, November 13, 2016
Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: chronic inflammatory diseases are at a substantially increased risk of cardiovascular events (CVE). Scarce data is available in patients with Giant cell arteritis (GCA) and Polymyalgia Rheumatica (PMR). Our objective was to analyze the incidence of CVE in these patients seen at a large University hospital.
Methods: we retrospectively reviewed electronic medical records (EMR) of patients registered between years 2000-2015 with the diagnosis of GCA or PMR. Patients fulfilling ACR 1990 criteria for GCA or ACR PMR 2012 criteria or with a diagnose made by a rheumatologist were included. Patients with history of CVE before diagnosis were excluded. Data regarding smoking status, blood pressure, obesity, diabetes, dyslipidemia, disease characteristics and treatments were recorded. CVE such as stroke or transient ischemic attack, coronary and peripheral vascular disease were identified from the EMR, during follow up. For patients with more than one CVE only the first one was considered for global incidence. Aortic aneurism (AA) was considered separately. Incidence rate with 95% CI of CVE is reported. In PMR patients a Cox proportional hazards models was fitted to analyze variables associated with CVE including age, sex, smoking, hypertension, diabetes mellitus, obesity, total cholesterol level, time on steroids, and use of aspirin.
Results: 872 PMR and 105 GCA were included . Demographic characteristics are shown in table 1. Among the 872 PMR patients (3945 patient-years (pt-yrs) of follow up)76 CVE occurred: incidence rate (cases per 1000 pt-yrs) : 19.3 (95% CI: 15.4-24.1); Females (F): 18 (14-23) and males (M): 24 (15-37). 46 patients suffered AA: incidence rate: 11.3/per 1000 pt-yrs (95% CI: 8.5-15); M: 22.3 (14.2-35) and F: 8.3 (5.7-12.2). Among the 105 ACG patients, 15 CVE occurred (501 pt-yrs of follow up): incidence rate: 29.9/per 1000 pt-yrs (95% CI: 18 – 49.6); M: 31.3 (7.8-125.3) and F: 29.7 (17.2-51.2). Nine patients had AA: incidence rate per 1000 pt-yrs: 17.9 (95% CI: 9.3–34.4); M: 30.4 (7.6-121.6) and F: 16 (7.6-33.6). The incidence rate of different CVE by gender, are shown in table 2. In the multivariate Cox proportional hazards model, variables associated with CVE were: diabetes mellitus: HR 3.3 (95% CI: 1.8-6.1), age at diagnosis: HR: 1.05 (95% CI: 1.01-1.08) and time on steroids (months of use): HR: 1.01 (95% CI: 1-1.02).
Conclusion: There was a high incidence of CVE and AA, in both patients with PMR and ACG. Diabetes, older age at diagnosis and prolonged use of steroids were significantly associated with more CVE. Table 1. Patient characteristics
| Variable | PMR (n=872) | ACG (n=105) |
| Females, n (%) | 678 (78) | 88 (84) |
| Mean age at diagnosis (SD) | 75.2 (7.9) | 76.5 (5.9) |
| Mean time follow up (years), (SD) | 4.8 (3.7) | 12.1 (6.1) |
| Mean erythrocyte sedimentation rate (SD) | 56.8 (25.4) | 70.6 (25) |
| Polymyalgia symptoms, n (%) | 872 (100) | 59 (56) |
| Hypertension at baseline, n (%) | 599 (68) | 73 (69.5) |
| Diabetes at baseline, n (%) | 64 (7.3) | 10 (9.5) |
| Obesity at baseline (BMI (weight(kg)/Height(m)2)>30, n (%) | 137 (16) | 11 (10.5) |
| Smoking, n (%) | ||
| Never | 676 (77.5) | 83 (79) |
| Former | 144 (16.5) | 12 (11.4) |
| Current | 52 (5.9) | 10 (9.5) |
| Median time on steroids (months) (IQR) | 18 (12-29) | 27.5 (18-42) |
Table 2. Incidence rate of CV events by gender
| PMR (n=872) | ACG (n=105) | |
| CV Event | Incidence rate/1000 patients-year (95 % CI) | Incidence rate/1000 patients-year (95 % CI) |
| CV Deaths | ||
| Global | 7.9 (5.6 -11) | 13.3 (6.3 – 27.9) |
| Males | 9.1 (4 – 18) | 14.4 (2 – 102.3) |
| Females | 7.6 (5.2 – 11) | 13.1 (5.9 – 20.2) |
| Myocardial infarction | ||
| Global | 7.6 (5.3 – 11) | 9.5 (3.9 – 22.8) |
| Males | 12.6 (7.0 – 22.8) | 14.6 (2.1 – 103.6) |
| Females | 6.2 (4.0 –9.6) | 8.7 (3.3 – 23.3) |
| Cerebrovascular accident | ||
| Global | 4.2 (2.8 – 6.3) | 9.7 (4.1 – 23.4) |
| Males | 2.8 (0.92 – 8.8) | 14.7 (2.1 – 104.3) |
| Females | 4.5 (2.9 – 7.0) | 8.9 (3.4 – 23.9) |
| Peripheral vascular disease | ||
| Global | 4.4 (2.8 – 6.9) | 9.8 (4.1 – 23.6) |
| Males | 5.8 (2.4 – 13.9) | 0 |
| Females | 4.0 (2.3 – 6.9) | 11.3 (4.7 – 27) |
To cite this abstract in AMA style:
Mollerach FB, Bertiller E, Gallardo MDLA, Martinez MJ, Scolnik M, Rosa J, Catoggio LJ, Soriano ER. Risk for Cardiovascular Disease in Giant Cell Arteritis and Polymyalgia Rheumatica [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/risk-for-cardiovascular-disease-in-giant-cell-arteritis-and-polymyalgia-rheumatica/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-for-cardiovascular-disease-in-giant-cell-arteritis-and-polymyalgia-rheumatica/