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Published on: February 8, 2019
Predictors of cerebrovascular accidents in giant cell arteritis in a defined population
R Pego-Reigosa1, C Garcia-Porrua, A Piñeiro
1Division of Neurology, Hospital Xeral-Calde, Lugo, Spain.
Insights
Cerebrovascular accidents (CVA) occur in 14.3% of giant cell arteritis (GCA) patients, with hypertension and hyperlipidemia as key predictors. Careful control of vascular risk factors is crucial for managing GCA patients.
Area of Science:
- Rheumatology
- Neurology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium arteries.
- Cerebrovascular accidents (CVA) are a known but not fully characterized complication of GCA.
Purpose of the Study:
- To determine the incidence and identify predictors of CVA in a population-based cohort of biopsy-proven GCA patients.
- To analyze the timing and territory of CVA events in relation to GCA diagnosis.
Main Methods:
- Retrospective analysis of 210 biopsy-proven GCA patients diagnosed between 1981 and 2001 in Lugo, Spain.
- Evaluation of clinical and laboratory data at diagnosis, including hypertension, hyperlipidemia, and anemia.
- Assessment of CVA occurrence, timing, and affected vascular territories.
Main Results:
- CVA occurred in 14.3% of GCA patients.
- Hypertension and hyperlipidemia at diagnosis were significant predictors of CVA.
- Anemia (hemoglobin < 12 g/dL) was negatively associated with CVA development within 10 years.
- Vertebrobasilar territory involvement was more frequent at the time of GCA diagnosis.
Conclusions:
- CVA is a significant complication of GCA, with specific vascular risk factors increasing susceptibility.
- Early identification and management of hypertension and hyperlipidemia are essential in GCA patients.
- Close monitoring and risk factor control are recommended for GCA patients to mitigate CVA risk.
Objective:
To examine the frequency and predictors of cerebrovascular accidents (CVA) in giant cell arteritis (GCA) patients from a defined population.
Methods:
Retrospective study of biopsy-proven GCA patients diagnosed from 1981 through 2001 at the single hospital for the population of Lugo (Northwest Spain).
Results:
Thirty (14.3%) of the 210 biopsy-proven GCA patients had CVA, 5 of them (16.7%) involving the vertebrobasilar territory. Five patients (4 of them involving the carotid territory) had CVA within the 2 years prior to the onset of GCA symptoms. Four patients had CVA within the first month after the diagnosis of the disease. Of these, 3 involved the vertebrobasilar territory. Another 5 patients suffered carotid stroke between the 4th and the 12th month after the disease diagnosis. The remaining 16 GCA patients had CVA (all but one involving the carotid territory) at least 1 year after the diagnosis of vasculitis. No differences in the clinical and laboratory features at the time of diagnosis between patients who had CVA and the rest of the biopsy-proven GCA patients were observed. However, hypertension and hyperlipidemia at the time of diagnosis of GCA were associated with the development of CVA (p < 0.05 for both). Also, anemia at the time of diagnosis (hemoglobin < 12 g/dL) [hazard ratio = 0.34 (95% CI 0.12 - 1.00; p = 0.05)] was negatively associated with CVA within the first 10 years after the diagnosis of the disease. Mortality in GCA patients with CVA was not significantly higher than that in patients without CVA (hazard ratio = 1.53; p = 0.14).
Conclusion:
The present study confirms that CVA may occur in GCA. Vertebrobasilar accidents are more common than carotid accidents at the time of diagnosis of the disease. Vascular risk factors should be carefully controlled in the follow-up of GCA patients.