Session Information
Date: Tuesday, October 23, 2018
Title: Vasculitis Poster III: Immunosuppressive Therapy in Giant Cell Arteritis and Polymyalgia Rheumatica
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Cardiovascular risk in systemic vasculitis may be higher than in normal population, but there is scarce data. Ethnic component plays a role on certain components of the disease and prevalence data on cardiovascular events vary worldwide. Our objective was to compare incidence rates of cardiovascular events (CVE) in pacients with giant cell arteritis (GCA) with matched controls from a university hospital-based health management organization (HMO).
Methods: All GCA patients (fulfilling ACR 1990 criteria) diagnosed after the year 2000 from the HMO and age and sex matched controls (1:2) were included. The follow-up period began at the index date, defined as the date of GCA diagnosis for GCA patients and the date of the first medical claim at the HMO for the non-GCA patients. Patients with history of cardiovascular events before diagnosis of GCA and controls with CVE before its correspondent case date of diagnosis were excluded. Subjects were then followed until they voluntarily left the HMO, a CVE occurred, the end of study (May 1st 2018), or death. Electronic medical records were manually reviewed and demographic, clinical and treatment data were collected. Incidence rates per 1000 person-years (PY) of each CVE after index dates were calculated and compared between groups. A multivariate cox regression analysis was performed to identify factors associated with CVE.
Results: 105 GCA patients and 210 controls were included and contributed 1276.9 and 1735.3 PY of follow up respectively. Patients’ characteristics are shown in table 1. Use of aspirin and diabetes were more frequent in GCA than in controls. Overall CVE incidence rate was similar between groups: 18.0 per 1000 PY in GCA patients (95% CI 12.3-25.4) and 14.4 per 1000 PY in controls (95% CI 9.9-20.6), p=0.22. Development of a thoracic aneurism was significantly more common in GCA patients (6.6 per 1000 PY, 95% CI 3.3-12.7, versus 2.3 per 1000 PY, 95% CI 0.9-6.1, p 0.04). Other CVE occurred at similar rates in both groups. In the multivariate cox regression analysis, after adjusting for traditional risk factors, a diagnosis of GCA was not associated with more cardiovascular events and only male sex was associated with an increased CV risk (OR 2.04, 95% CI 1.06-3.95, p 0.03). Treatment with statins was protective (OR 0.38, 95% CI 0.18-0.80, p=0.01).
Conclusion: as previously described, we found an increased risk of thoracic aneurism in GCA patients in comparison with matched controls. Other CVE were similar across groups.
|
GCA patients (n=105) |
Controls (n=210) |
p | |
| Age, years , media (SD) | 75.5 (11.4) | 73.4 (8.9) | 0.08 |
| Female, n (%, 95% CI) | 88 (83.8, 75.4-89.7) | 182 (85.8, 80.4-89.9) | 0.63 |
| Arterial hypertension, n (%, 95% CI) | 72 (68.6, 59.0-76.8) | 148 (69.8, 63.3-75.6) | 0.82 |
| Diabetes, n (%, 95% CI) | 10 (9.5, 5.2-16.9) | 5 (2.4, 0.9-5.6) | 0.005 |
| Ever Smoker, n (%, 95% CI) | 22 (20.9, 14.2-29.9) | 44 (20.8, 15.8-26.8) | 0.97 |
| Dyslipidemia, n (%, 95% CI) | 45 (43.3, 34.0-53.0) | 68 (32.1, 26.1-38.7) | 0.06 |
| Obesity, n (%, 95% CI) | 11 (10.5, 5.9-18.0) | 24 (11.3, 7.7-16.4) | 0.82 |
| Aspirin user, n (%, 95% CI) | 26 (24.8, 17.4-33.9) | 18 (8.5, 5.4-13.1) | <0.001 |
| Thoracic aneurism, n (%, 95% CI) | 8 (7.6, 3.8-14.6) | 4 (1.9, 0.7-4.9) | 0.01 |
| Thoracic aneurism, incidence rate, per 1000 patient-years (95% CI) | 6.6 (3.3-12.7) | 2.3 (0.9-6.1) | 0.04 |
| Abdominal aneurism, n (%, 95% CI) | 1 (0.9, 0.1-6.5) | 2 (0.9, 0.2-3.7) | 0.99 |
| Abdominal aneurism, incidence rate, per 1000 patient-years (95% CI) | 0.8 (0.1- 5.9) | 1.2 (0.2-4.8) | 0.41 |
| Stroke,n (%, 95% CI) | 6 (5.7, 2.6-12.2) | 9 (4.2, 2.2-7.9) | 0.56 |
| Stroke, incidence rate, per 1000 patient-years (95% CI) | 4.1 (2.2-10.5) | 4.7 (2.7-9.9) | 0.42 |
| Coronary event, n (%, 95% CI) | 5 (4.8, 1.9-11.0) | 8 (3.8, 1.9-7.4) | 0.68 |
| Coronary event, incidence rate, per 1000 patient-years (95% CI) | 4.8 (2.2-10.3) | 5.3 (2.8-10.0) | 0.43 |
| Peripheral arteriopathy, n (%, 95% CI) | 5 (4.8, 1.9 -11.0) | 3 (1.4, 0.4-4.3) | 0.08 |
|
Peripheral arteriopathy, incidence rate, per 1000 patient-years (95% CI) |
4.1 (1.6-9.3) | 1.7 (0.5-5.3) | 0.13 |
| Any cardiovascular event, n (%, 95% CI) | 23 (21.9, 14.9-30.9) | 25 (11.8, 8.1-16.9) | 0.02 |
|
Any cardiovascular event, incidence rate, per 1000 patient-years (95% CI) |
18.0 (12.3-25.4) | 14.4 (9.9-20.6) | 0.22 |
| Death, n (%, 95% CI) | 7 (6.7, 3.2-13.4) | 26 (12.3, 8.5-17.4) | 0.12 |
| Cardiovascular death, n (%, 95% CI) | 0 | 5 (20.0, 0.8-41.4) | 0.19 |
| Follow up time, years, median (IQR) | 11.3 (7.5-15.9) | 7.8 (4.3-11.9) | <0.001 |
To cite this abstract in AMA style:
Mollerach FB, Scolnik M, Marin Zucaro NM, Martinez P JM, Soriano ER. Incidence of Cardiovascular Events in Giant Cell Arteritis: A Matched-Control Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/incidence-of-cardiovascular-events-in-giant-cell-arteritis-a-matched-control-study/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-of-cardiovascular-events-in-giant-cell-arteritis-a-matched-control-study/