title: Incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years.
abstract: OBJECTIVE
  To determine the incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis (GCA).
  
  
  METHODS
  The cohort of all residents of Olmsted County, Minnesota, in whom GCA was diagnosed between January 1, 1950, and December 31, 1999, was followed up. The incidence of aortic aneurysm, aortic dissection, and large-artery stenosis was determined. Possible predictors and correlates of large-artery complication were assessed.
  
  
  RESULTS
  Forty-six incident cases of large-artery complication (representing 27% of the 168 patients in the cohort) were identified. These included 30 incident cases (18%) of aortic aneurysm and/or aortic dissection. Of these cases, 18 (11%) involved the thoracic aorta, with aortic dissection developing in 9 (5%). There were 21 incident cases (13%) of large-artery stenosis. Fifteen patients (9%) had incident cervical artery stenosis, and 6 (4%) had incident subclavian/axillary/brachial artery stenosis. One patient (0.6%) had incident iliac/femoral artery stenosis attributable to GCA. Hyperlipidemia and coronary artery disease were associated with aortic aneurysm and/or dissection (P < 0.05 for both). Cranial symptoms (headache, scalp tenderness, abnormal temporal arteries) were negatively associated with large-artery stenosis (hazard ratio [HR] 0.10 [95% confidence interval (95% CI) 0.03-0.35, P < 0.0005]), as was a higher erythrocyte sedimentation rate (HR 0.80 [95% CI 0.67-0.95, P < 0.05] per 10 mm/hour).
  
  
  CONCLUSIONS
  Large-artery complication is common in GCA. Increased awareness of large-artery complication in GCA, particularly early-occurring aortic dissection, may decrease associated mortality.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Nuenninghoff
authors.forename: Gene G
authors.initials: GG
authors.lastname: Hunder
authors.forename: Teresa J H
authors.initials: TJ
authors.lastname: Christianson
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000453:epidemiology*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000453:epidemiology*; D001366:Axillary Artery; D001916:Brachial Artery; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D013700:Giant Cell Arteritis / Q000453:epidemiology*; D006801:Humans; D007083:Iliac Artery; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013349:Subclavian Steal Syndrome / Q000175:diagnosis / Q000453:epidemiology*