Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis

Objective. To evaluate the impact of traditional cardiovascular risk factors, carotid atherosclerosis and the effect of anti-platelet/anti-coagulant therapy on the occurrence of severe cranial ischaemic events (CIEs) in GCA. Methods. We identified 180 Reggio Emilia (Italy) residents with biopsy-proven GCA diagnosed between 1986 and 2005. We evaluated data on demographics, clinical features, laboratory investigations, cardiovascular risk factors, anti-platelet/anti-coagulant use and carotid atherosclerosis. Results. Systemic signs/symptoms were significantly less frequent (P 0.004) and ESR and C-reactive protein (CRP) values at diagnosis were significantly lower (P 0.03 and P 0.04, respectively) in patients with CIEs. The prevalence of hypertension and ischaemic heart disease was significantly higher in patients with CIEs than in those without (P 0.01 and P 0.006, respectively). Patients treated with anti-platelet/anti-coagulant therapy were significantly more likely to suffer CIEs than those without (P 0.03), while CIEs were significantly associated with ischaemic heart disease in this subset of patients (P 0.02). By multivariate logistic regression, we found that the best predictors for the development of severe CIEs included the absence of high (5.38 mg/dl) CRP levels at diagnosis (OR 0.31, 95 CI 0.08, 1.20), the absence of systemic manifestations (OR 0.30, 95 CI 0.08, 1.08), the presence of hypertension (OR 7.77, 95 CI 0.83, 72.76), and a past history of ischaemic heart disease (OR 8.65, 95 CI 0.92, 80.95). Conclusions. In GCA, hypertension, a past history of ischaemic heart disease and a low inflammatory response are associated with a higher risk of developing severe CIEs.