Giant Cell Arteritis and Cardiovascular Events in the French Apogee Cohort. A Population-Based Study Using the French Health Insurance System Database

Grégory Pugnet¹, Laurent Sailler², Robert Bourrel³, Jean-Louis Montastruc⁴ and Maryse Lapeyre-Mestre⁴, ¹Department of Internal Medicine, Toulouse University Hospital, University of Toulouse, INSERM UMR 1027, Toulouse, France, ²Department of Internal Medicine, Toulouse University Hospital, Toulouse, France, ³Service Médical, Caisse Nationale de l'Assurance Maladie échelon régional, Midi-Pyrénées, Toulouse, France, ⁴Department of Clinical Pharmacology, Toulouse University Hospital, INSERM U1027, University of Toulouse, France, Toulouse, France

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease and giant cell arteritis

Session Information

Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose: The risk of cardiovascular events (CVE) during giant cell arteritis (GCA) has rarely been quantified in population-based studies. Our objective was to quantify the risk of CVE during GCA in a population-based GCA cohort and to compare it to controls using the French Health Insurance system reimbursement database.

Methods: The APOGEE cohort includes most incident GCA patients of the Midi-Pyrénées County, south of France from January 2005 to December 2008. GCA patients are identified in the French Health Insurance System database by their international classification of diseases code, 10^th version (M31.5: “GCA with polymyalgia rheumatica (PMR)” or M31.6: “GCA without PMR”). Incident cases are defined by a continuous glucocorticosteroids (GCs) course lasting for at least 6 months, and no previous exposure to GCs during the 6 preceding months. For each case two controls matched on gender and age were randomly selected in the FIHS database. The cardiovascular risk factors (CVRF) were identified through the exposure to drugs prescribed to treat diabetes mellitus, hypertension or dyslipidaemia CVE were cerebrovascular disease (CVD), coronary disease (CD), peripheral arterial disease (PAD) congestive heart failure and atrial fibrillation. New CVE were identified by analysing comprehensive data on drugs’ reimbursement, diagnostic procedures, hospital stays and new cardiovascular diseases registered in the database. Serious CVE were defined as CVE leading to hospitalization > 24 hours or death. Follow-up ended in April 2011. We compared the occurrence of the first CVE in cases and controls by a log-rank test. The analysis was then stratified on exposure to statins or anti-platelets drugs (APD). We did not perform a multivariate analysis because of the limited number of events.

Results: The cohort included 103 patients (80 women (77.7%);mean age 74.8 (±9) years; mean follow-up 48.9 (±14.8) months). The mean initial GC dosage was 54 (± 27) mg/d. At study entry, there was no difference between cases and controls for CVRF except for diabetes mellitus, which was more prevalent in controls (p<0.01). CVE all combined as well as serious CVE occurred more frequently in GCA patients (respectively, 33% vs. 19%, RR= 1.8 [1.25-2.53], p= 0.0011 and 15.5% vs. 7.8%, RR= 2.0 [1.15-3.49], p= 0.014). The mortality rate among GCA patients was not different from matched-controls (8/103 vs. 18/206, p> 0.05).

Conclusion: In the general population, the probabilities of first non-serious and serious CVE are significantly increased among incident GCA patients. Further studies are necessary to measure the protective effects of statins and anti-platelets drugs in these patients.

Disclosure:

G. Pugnet,
None;

L. Sailler,
None;

R. Bourrel,
None;

J. L. Montastruc,
None;

M. Lapeyre-Mestre,
None.

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