Aortic and Carotid Complications in Patients with Giant Cell Arteritis

  • 0Jones Eye Institute, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR.
American journal of ophthalmology +

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Abstract

PURPOSE

To assess the risk of developing aortic aneurysms (AAs) and carotid artery stenosis (CAS) in patients with giant cell arteritis (GCA), particularly among those presenting with and without visual symptoms.

DESIGN

Retrospective cohort study.

SUBJECTS

A total of 7,294 patients aged ≥50 years with biopsy-proven GCA (temporal artery biopsy within two weeks of diagnosis and ≥3 prednisone refills) were identified and compared to 265,948 control patients presenting with tension-type headache utilizing the TriNetX US Collaborative Network. A secondary comparison was performed between GCA patients with (n=2,390) and without (n=5,222) visual symptoms (e.g., diplopia, amaurosis fugax, vision loss).

METHODS

GCA was defined using ICD-10 codes M31.5 and M31.6. Patients with a history of other vasculitides, prior aortic aneurysms, or major thrombotic events were excluded. Propensity score matching (PSM) was used to balance demographics, socioeconomic factors, comorbidities, substance use, and laboratory/vital parameters, resulting in matched cohorts for each comparison. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models to account for time to onset of vascular complications.

MAIN OUTCOME MEASURES

Primary outcomes were the 5-year risks of (1) thoracic aortic aneurysms, (2) thoracoabdominal aortic aneurysms, (3) abdominal aortic aneurysms, and (4) carotid artery stenosis.

RESULTS

After matching, 7,252 patients remained in each arm for the primary GCA versus control comparison. GCA patients had a significantly higher 5-year risk of any aortic aneurysm (3.59% vs 1.75%; aHR, 1.98; 95% CI, 1.59-2.45), including thoracic (2.23% vs 1.02%; aHR, 2.01; 95% CI, 1.59-2.77), thoracoabdominal (0.32% vs 0.14%; aHR, 3.68; 95% CI, 1.50-9.05), and abdominal (1.80% vs 0.82%; aHR, 2.03; 95% CI, 1.49-2.77). Carotid artery stenosis was also elevated in GCA (7.20% vs 4.37%; aHR, 1.59; 95% CI, 1.38-1.84). In the subanalysis of GCA patients, the 5-year risk of any aortic aneurysm was comparable between those with and without visual symptoms (3.58% vs 3.23%; aHR, 1.14; 95% CI, 0.83-1.57). However, carotid artery stenosis occurred more frequently in GCA patients presenting with visual symptoms (8.95% vs 7.43%; aHR, 1.24; 95% CI, 1.01-1.53).

CONCLUSIONS

Patients with GCA demonstrate a substantially increased risk of aortic aneurysms, particularly thoracic aortic aneurysms, compared to matched controls. Although having visual symptoms did not correlate with additional aortic risk, it was associated with a higher risk of carotid artery stenosis.

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