Background/Purpose:

Giant cell arteritis (GCA) is a large vessel vasculitis affecting individuals over 50 years of age. Multiple epidemiological studies have determined increased risk of cardiovascular diseases (CVD) in GCA. There are no guidelines to assess CV risk in GCA. The study objective was to review current practice of monitoring CV risk in GCA by rheumatologists in a single center academic rheumatology practice.

Methods:

Retrospective chart review of patients diagnosed with GCA was conducted. Data included demographics, comorbid conditions including CVD, obesity, diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), tobacco use, and physician intervention for CV risk reduction which was defined as measuring lipid profile (LP), use of antiplatelet agent, smoking cessation counseling, lifestyle modification counseling defined as education on healthy diet, exercise, and weight loss. LP measurement was either done at rheumatologists’ office or documented as done outside by primary care physician or cardiologist. We used backward elimination logistic regression to assess associations between the likelihood of physician intervention for CV risk reduction, with respect to age, gender, presence or absence of CV risk factors (BMI, tobacco use, DM, HTN, HLD), and prior CVD. HLD was defined as per American College of Cardiology 2013 guidelines.

Results:

148 patients with GCA were seen from 2008 – 2017. The majority of patients were female (111, 75%) with median age of 75 (range 51-93) years. Prevalence of HTN, HLD, CVD, and DM was 72% (n=106), 53% (n=79), 34% (n=50), and 21% (N=31), respectively. Few patients were active smokers (13, 9%) but many were overweight/obese (93, 64%). LP was assessed at least once in only 18% (n=26) patients, and 43% (n=63) were taking a statin. 67% (n=99) patients were on antiplatelet or anticoagulation (AC) therapy. Lifestyle modification counseling was documented in 45% (n=67) patients. Smoking cessation was discussed in 31% smokers. Among the patients with prior CVD, 82% (n=41) were on antiplatelet/AC; 14% (n=7) had LP assessed; and lifestyle modification counseling was documented in 36% (n=18). Male gender and high BMI were associated with higher likelihood of lifestyle modification counseling, (OR 3.4; 95% CI 1.2-10.2) and (OR 1.16; CI 1.1-1.3), respectively. Measuring LP was more common in men (OR 5.2; 95% CI 1.4-19.5) and in subjects with HLD (OR 32.1; 95% CI 6.0-172.1).

Conclusion:

This single center study identified potential areas of improvement in the monitoring of CV risk in patients with GCA. Assessment of lipid profile, lifestyle modification counseling, and smoking cessation were infrequently performed or documented in patients with GCA. The likelihood of physician intervention for CV risk reduction was associated with presence of traditional CV risk factors rather than consideration of GCA as a strong independent risk for CVD. Developing guidelines to monitor CV risk in GCA will be useful for clinicians and may help to reduce CV morbidity and mortality in this population.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-practice-of-cardiovascular-risk-assessment-in-giant-cell-arteritis-a-single-center-study/