Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis.
OBJECTIVE
To evaluate the impact of traditional cardiovascular risk factors, carotid atherosclerosis and the effect of anti-platelet/anti-coagulant therapy on the occurrence of severe cranial ischaemic events (CIEs) in GCA.


METHODS
We identified 180 Reggio Emilia (Italy) residents with biopsy-proven GCA diagnosed between 1986 and 2005. We evaluated data on demographics, clinical features, laboratory investigations, cardiovascular risk factors, anti-platelet/anti-coagulant use and carotid atherosclerosis.


RESULTS
Systemic signs/symptoms were significantly less frequent (P = 0.004) and ESR and C-reactive protein (CRP) values at diagnosis were significantly lower (P = 0.03 and P = 0.04, respectively) in patients with CIEs. The prevalence of hypertension and ischaemic heart disease was significantly higher in patients with CIEs than in those without (P = 0.01 and P = 0.006, respectively). Patients treated with anti-platelet/anti-coagulant therapy were significantly more likely to suffer CIEs than those without (P = 0.03), while CIEs were significantly associated with ischaemic heart disease in this subset of patients (P = 0.02). By multivariate logistic regression, we found that the best predictors for the development of severe CIEs included the absence of high (>5.38 mg/dl) CRP levels at diagnosis (OR = 0.31, 95% CI 0.08, 1.20), the absence of systemic manifestations (OR = 0.30, 95% CI 0.08, 1.08), the presence of hypertension (OR = 7.77, 95% CI 0.83, 72.76), and a past history of ischaemic heart disease (OR = 8.65, 95% CI 0.92, 80.95).


CONCLUSIONS
In GCA, hypertension, a past history of ischaemic heart disease and a low inflammatory response are associated with a higher risk of developing severe CIEs.
Salvarani
C
C
Unità Operativa di Reumatologia, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. salvarani.carlo@asmn.re.it
Della Bella
C
C
Cimino
L
L
Macchioni
P
P
Formisano
D
D
Bajocchi
G
G
Pipitone
N
N
Catanoso
M G
MG
Restuccia
G
G
Ghinoi
A
A
Boiardi
L
L
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D002340:Carotid Artery Diseases / Q000150:complications; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012307:Risk Factors
D000925:Anticoagulants; D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D002097:C-Reactive Protein