Which Patients with Giant Cell Arteritis Will Develop Cardiovascular or Cerebrovascular Disease? A Clinical Practice Research Datalink Study.

TLDR: Patients with GCA are more likely to develop cerebrovascular disease or CVD than age-, sex-, and location-matched controls and further work is needed to understand how this risk may be mediated by specific behavioral, social, and economic factors.

Abstract: Objective. To evaluate the risk of cerebrovascular disease and cardiovascular disease (CVD) in patients with giant cell arteritis (GCA), and to identify predictors. Methods. The UK Clinical Practice Research Datalink 1991–2010 was used for a parallel cohort study of 5827 patients with GCA and 37,090 age-, sex-, and location-matched controls. A multivariable competing risk model (non-cerebrovascular/CV-related death as the competing risk) determined the relative risk [subhazard ratio (SHR)] between patients with GCA compared with background controls for cerebrovascular disease, CVD, or either. Each cohort (GCA and controls) was then analyzed individually using the same multivariable model, with age and sex now present, to identify predictors of CVD or cerebrovascular disease. Results. Patients with GCA, compared with controls, had an increased risk SHR (95% CI) of cerebrovascular disease (1.45, 1.31–1.60), CVD (1.49, 1.37–1.62), or either (1.47, 1.37–1.57). In the GCA cohort, predictors of “cerebrovascular disease or CVD” included increasing age, > 80 years versus < 65 years (1.98, 1.62–2.42), male sex (1.20, 1.05–1.38), and socioeconomic status, most deprived quintile versus least deprived (1.34, 1.01–1.78). These predictors were also present within the non-GCA cohort. Conclusion. Patients with GCA are more likely to develop cerebrovascular disease or CVD than age-, sex-, and location-matched controls. In common with the non-GCA cohort, patients who are older, male, and from the most deprived compared with least deprived areas have a higher risk of cerebrovascular disease or CVD. Further work is needed to understand how this risk may be mediated by specific behavioral, social, and economic factors.

Full text

Robson, J. C., Kiran, A., Maskell, J., Hutchings, A., Arden, N.,
Dasgupta, B., Hamilton, W. T., Emin, A., Culliford, D., & Luqmani, R.
(2016). Which patients with giant cell arteritis will develop
cardiovascular or cerebrovascular disease? A clinical practice
research datalink study.
Journal of Rheumatology
,
43
(6), 1085-1092.
https://doi.org/10.3899/jrheum.151024
Peer reviewed version
Link to published version (if available):
10.3899/jrheum.151024
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Which patients with giant cell arteritis will develop cardiovascular or
cerebrovascular disease? A Clinical Practice Research Datalink study
Joanna C Robson*. Consultant Senior Lecturer in Rheumatology,
Faculty of Health and Applied Sciences, University of the West of England,
Bristol, & Hon Senior Lecturer, School of Clinical Sciences at South
Bristol, University of Bristol, & Hon Consultant in Rheumatology, University
Hospitals Bristol NHS Trust. Academic Rheumatology Unit,The Courtyard, Bristol
Royal Infirmary, Bristol, BS2 8HW. Tel: +44 (0) 117 342 22904, Fax: +44 (0)117 342
3841, Jo.Robson@uwe.ac.uk
Amit Kiran. Statistician, Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Science, University of Oxford, Nuffield Orthopaedic Centre, Windmill
Road, Oxford, OX3 7HE.
Joe Maskell. Data manager, Faculty of Medicine, University of Southampton,
Southampton General Hospital, South Academic Block, Tremona Road,
Southampton, SO16 6YD.
Andrew Hutchings. Lecturer, Department of Health Services Research and Policy,
London School of Hygiene and Tropical Medicine Room, 15-17 Tavistock Place,
London, WC1H 9SH.

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Nigel Arden. Professor of Rheumatology, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Science, University of Oxford, Nuffield
Orthopaedic Centre, Windmill Road, Oxford, OX3 7HE.
Bhaskar Dasgupta. Professor of Rheumatology, Southend University Hospital NHS
Trust, Prittlewell chase, Westcliff-on-sea, SS0 0RY.
William Hamilton. Professor of Primary Care Diagnostics, University of Exeter Medical
School, College House, EX1 2LU
Akan Emin. UK Cardiothoracic Transplant Research Fellow, Clinical Effectiveness
Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London,
WC2A 3PE.
David Culliford. Senior Medical Statistician, Faculty of Medicine, University of
Southampton, Southampton General Hospital, South Academic Block, Tremona
Road, Southampton, SO16 6YD.
Raashid Luqmani. Professor of Rheumatology, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Science, University of Oxford, Rheumatology
Dept, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE.
*Corresponding Author

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Competing Interest
List of competing interests: 1) Joanna Robson (JR), Joe Maskell (JM), Andrew
Hutchings (AH), Nigel Arden (NA), Bhaskar Dasgupta (BD), Willie Hamilton (WH),
David Culliford (DC), Akan Emin (AE) and Raashid Luqmani (RL) received a grant
from the NIHR Research for Patient Benefit (RfPB) Programme to fund this study. JR,
AK, JM, AH, NA, BD, WH, DC, AE and RL had no support from any commercial
companies for the submitted work; 2) AK, JM, AH, WH, DC, AE have no relationships
with companies which might have an interest in the submitted work in the previous 3
years. NA has the following relationships; consultancies for Flexion (PharmaNet), Lily,
Merck, Q-Med, Roche and Smith & Nephew; grants/ grants pending with Novartis,
Pfizer, Schering-Plough and Servier and received payment for lectures from Amgen,
GSK, NiCox and Smith & Nephew. BD has the following relationships; board
membership Roche, Servier, GSK-advisor in GCA; consultancy for Mundi
Pharma,GSK,Novartis on PMR. RL has the following relationships; consultancies for
Nordic Pharma, Chemocentryx, Human Genome Science, GSK; grants/grants
pending with Roche and GSK. 3) JR, AK, JM, AH, NA, BD, WH, DC, AE, RL their
spouses, partners, or children have no financial relationships that may be relevant to
the submitted work; and 4) JR, AK, JM, NA, WH, DC, AE, RL have no non-financial

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interests that may be relevant to the submitted work. AH and BD are members of the
group that produced the British Society of Rheumatology/ British Health Professionals
in Rheumatology 2010 guidelines for the management of giant cell arteritis. BD, AH,
RL are members of the group updating these guidelines.
Contributors
All authors contributed to the study proposal, design of the analysis and interpretation
of the findings. JR and AK produced the analysis plan. JM was responsible for data
extraction. AK and AH undertook the analysis with input from JR and RL. All authors,
internal and external, had full access to the data (including statistical reports and
tables) in the paper and can take responsibility for the integrity of the data and the
accuracy of the data analysis. JR wrote the first draft of the paper which was revised
by all authors. JR and AK will act as guarantors.
Acknowledgements: Nil.
Funding: Grant from the NIHR Research for Patient Benefit (RfPB) Programme.
Funders reviewed the study design protocol but had no role in collection, analysis,
interpretation of data, writing of the report, or decision to submit the article for
publication.
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