Risk factors for acute coronary syndrome in patients with giant cell arteritis: a scoping review
Eugénie Pelletier1, Caitlyn Kanters1, Stéphanie Ducharme-Bénard2
1Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Insights
Giant cell arteritis (GCA) patients face higher risks for acute coronary syndrome (ACS). Older age, male sex, and the early post-diagnosis period are key risk factors for cardiac events in GCA patients.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Epidemiology
Background:
- Giant cell arteritis (GCA) is a vasculopathy increasing cardiovascular and thromboembolic risks, including acute coronary syndrome (ACS).
- Early identification of high-risk GCA patients is crucial for preventive strategies.
- This review focuses on demographic and clinical factors associated with ischemic cardiac events in GCA.
Purpose of the Study:
- To summarize demographic and clinical characteristics of GCA patients at elevated risk for ischemic cardiac events.
- To identify predictors of acute coronary syndrome (ACS) in patients diagnosed with giant cell arteritis (GCA).
Main Methods:
- A systematic scoping review was conducted using PubMed, Cochrane CENTRAL, and EMBASE.
- Studies included adults (≥50 years) with confirmed GCA and reported ACS outcomes.
- Data were synthesized qualitatively, with key quantitative variables extracted.
Main Results:
- Nine studies involving 14,484 GCA patients were analyzed.
- Ischemic cardiac events occurred in 9.8% of patients during follow-up.
- Predictors of ACS included early post-diagnosis period, male sex, and older age at diagnosis.
Conclusions:
- Older age, male sex, and the early post-GCA diagnosis phase are associated with the highest ACS risk.
- Current evidence is limited by heterogeneity and incomplete reporting, necessitating further research.
- Clinicians should monitor GCA patients closely for cardiac events, especially early in the disease course.
Background:
Giant cell arteritis (GCA) is a chronic inflammatory vasculopathy associated with an increased risk of cardiovascular and thromboembolic complications, including acute coronary syndrome (ACS). Early identification of high-risk subgroups is essential for targeted prevention. This scoping review summarizes the demographic and clinical characteristics of patients with GCA who are at elevated risk for ischemic cardiac events.
Design:
Scoping review.
Methods:
We systematically searched PubMed, Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), and EMBASE (Ovid interface) for studies evaluating the association between GCA and ACS, applying predefined eligibility criteria. Eligible studies included adults aged ⩾50 years with confirmed GCA and reported ACS outcomes. Data were synthesized qualitatively, and key quantitative variables were extracted.
Results:
Nine studies met inclusion criteria, encompassing 14,484 patients with GCA. Of these, 71.5% were women, 77% had a new GCA diagnosis, and 9.8% experienced an ischemic cardiac event during follow-up. Consistently reported predictors of ACS included the early post diagnosis period, male sex, and older age at diagnosis. Other potential risk factors such as hypertension, corticosteroid use, and concomitant polymyalgia rheumatica were inconsistently reported or lacked statistical significance. Substantial heterogeneity in study design, definitions, and follow-up duration precluded pooled analysis.
Conclusion:
Older age, male sex, and the period shortly after GCA diagnosis appear to confer the highest risk for ACS, though current evidence is limited by methodological variability and incomplete reporting. Prospective studies with standardized definitions, detailed treatment data, and longitudinal follow up are needed to refine cardiovascular risk stratification in GCA. Meanwhile, clinicians should maintain heightened vigilance for cardiac events in high-risk patients, particularly early in the disease course.
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