Risk of cardiovascular events in giant cell arteritis: systematic review and meta-analysis
Sawai Singh Rathore1, Prakhyath Srikaram2, Samyukta Gudena3
1Dr. Sampurnanand Medical College, Jodhpur, India.
Insights
Giant cell arteritis (GCA) significantly increases the risk of cardiovascular events, including heart attack, stroke, and venous thromboembolism. Vigilant cardiovascular monitoring is crucial for patients with GCA.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis associated with increased cardiovascular and thromboembolic risks.
- Existing research on cardiovascular disease in GCA presents varied findings, necessitating a comprehensive analysis.
Purpose of the Study:
- To quantify the association between GCA and various cardiovascular outcomes.
- To provide a thorough evaluation of the cardiovascular burden in GCA patients.
Main Methods:
- A meta-analysis of 14 studies involving 609,954 patients.
- Random effect models were used to calculate odds ratios and 95% confidence intervals.
- Publication bias was assessed using funnel plots and statistical tests.
Main Results:
- GCA patients showed significantly higher odds of cardiovascular events (OR=1.81), myocardial infarction (OR=1.63), coronary artery disease (OR=1.51), aortic aneurysm/dissection (OR=1.95), peripheral artery disease (OR=2.02), and stroke (OR=1.52).
- Increased odds were also observed for venous thromboembolism (OR=1.92), deep vein thrombosis (OR=2.09), and pulmonary embolism (OR=2.45).
- No significant publication bias was detected.
Conclusions:
- GCA patients require vigilant cardiovascular monitoring and proactive management strategies.
- Further research is needed to identify specific risk factors for cardiovascular complications in GCA.
Objective:
Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies suggest an increased risk of cardiovascular disease in GCA, but results vary. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA.
Methods:
A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism.
Results:
The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55-2.15), acute myocardial infarction (OR = 1.63, 95% CI = 1.34-1.97), coronary artery disease (OR = 1.51, 95% CI = 1.09-2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55-2.46), peripheral artery disease (OR = 2.02, 95% CI = 1.69-2.41), stroke (OR = 1.52, 95% CI = 1.25-1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73-2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50-2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38-4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis.
Conclusion:
The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients.
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