Background/Purpose: No population-based study has assessed serious cardiovascular events (sCVE) risk factors in Giant Cell Arteritis (GCA). The aim of our study was to identify risk factors associated with sCVE occurrence in GCA in the general population.
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 National Health Insurance System (FNHIS) database by their international classification of diseases code, 10th 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 FNIHS database. New CVE were identified by analyzing 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. Serious CVE identified was: cerebrovascular disease, coronary disease, peripheral arterial disease, congestive heart failure and atrial fibrillation. Follow-up ended in April 2011. We used a multivariate Cox proportional hazards model to identify independent predictors of the first sCVE in the whole population and in GCA patients.
Results: The cohort included 103 patients (80 women, mean age 74.8 ± 9 years, mean follow-up 48.9 ± 14.8 months) and 206 controls. At study entry, there was no difference between cases and controls for cardiovascular co-morbidities except for diabetes mellitus, which was more prevalent in controls (p<0.01). Serious CVE occurred more frequently in GCA patients (15.5% vs. 7.8%, p= 0.014). Independent risk factors for sCVE occurrence were GCA (HR= 1,99 [1.02-3.9]; p< 0.05), age over 77 (HR= 4.31 [1.78-10.45]; p=0.001), a previous history of diabetes (HR= 2.54 [1.19-5.41] ; p=0.02) or chronic heart failure (CHF) (HR= 8.24 [1.89-35.84] ; p=0.005). Independent risk factors for sCVE occurrence in the GCA cohort were age over 77 (HR= 7.07 [2.04-24.47]; p= 0.002) and a previous history of CHF (HR= 8.15 [1.86-35.72]; p= 0.005). Exposure to statins for more than 18 months decreased the risk of sCVE occurrence in the whole cohort (HR= 0.26 [0.06-1.11]; p= 0.07) and in the GCA cohort (HR= 0.35 [0.11-1.09] p= 0.071).
Conclusion: GCA is an important independent cardiovascular risk factor and statins may prevent sCVE occurrence. Older GCA patients with a previous history of CHF have a very high risk of developing serious cardiovascular complication and should be monitored closely.
Disclosure:
G. Pugnet,
None;
L. Sailler,
None;
G. Moulis,
None;
J. P. Fournier,
None;
R. Bourrel,
None;
J. L. Montastruc,
None;
M. lapeyre-Mestre,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/serious-cardiovascular-events-risk-factors-in-giant-cell-arteritis-a-population-based-study-in-the-french-apogee-cohort/