Increased mortality due to cardiovascular disease in patients with giant cell arteritis in northern Sweden.
OBJECTIVE
To study the cause of death pattern in patients with giant cell arteritis (GCA) or polymyalgia rheumatica (PMR), and to analyze the effect of the disease, or its therapy, on the risk of a cardiovascular event (CVE).


METHODS
Patients with biopsy proven GCA or with PMR, whose condition was diagnosed between 1973 and 1979, were followed until December 31, 1995. The standardized mortality ratio (SMR) was estimated using data for the population of Västerbotten, Northern Sweden, as reference value. Information for sex, age at diagnosis, erythrocyte sedimentation rate (ESR) at diagnosis, corticosteroid therapy, comorbidity from diagnosis, and date and cause of death was collected.


RESULTS
A total of 136 patients with GCA and 35 with PMR were identified. At the time of followup 114 patients with GCA and 25 with PMR were deceased. The overall mortality was significantly increased in the female patients, SMR = 133 (95% CI 110-162). Death due to cardiovascular disease (CVD) was significantly increased in both women and men, SMR = 149 (95% CI 118-189) and 158 (95% CI 112-224), respectively, and mainly due to ischemic heart disease. An excess mortality was found in women with the highest ESR, the highest prescribed dose of prednisolone at diagnosis, or a daily prednisolone dose of 10 mg or more one year after diagnosis. In multiple Cox regression analysis, male sex and hypertension significantly increased the risk of a CVE.


CONCLUSIONS
Death due to CVD was increased in patients with GCA. Increased mortality was related to either the corticosteroid therapy itself or insufficient control of inflammation.
Uddhammar
Agneta
A
Department of Public Health and Clinical Medicine, University of Umeå, Sweden.
Eriksson
Anna-Lena
AL
Nyström
Lennarth
L
Stenling
Roger
R
Rantapää-Dahlqvist
Solbritt
S
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology
D005938:Glucocorticoids; D011239:Prednisolone