Risk of cardiovascular events in giant cell arteritis: systematic review and meta-analysis

Abstract

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.

Keywords: Aortic aneurysm; Aortic dissection; Cardiovascular event; Cerebrovascular event; Coronary artery disease; Giant cell arteritis; Myocardial infarction; Peripheral artery disease; Stroke; Venous thromboembolism.