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Background: Giant Cell Arteritis (GCA) is the most frequent vasculitis in patients older than 50 years-old. Increasing use of imaging tools for the diagnosis of GCA led to recognition of extracranial Large-Vessel (LV-GCA) involvement in a significant proportion of patients. Around two-thirds of patients with GCA are reported to have extracranial LV-GCA [1,2]. GCA phenotypes may vary according to age at diagnosis, with cranial manifestations being more prominent in older patients and LV-GCA more frequent in patients younger than 65 years-old [3]. Atherosclerosis is highly prevalent among patients with an advanced age. However, little is known about the coexistence of these two vascular diseases.
Objectives: The aim of this work is to describe the prevalence of atherosclerosis in patients with GCA.
Methods: Thirty-eight patients with GCA followed at our vasculitis clinic were included. GCA was diagnosed according to local imaging protocol with subsequent Vascular Ultrasound (VUS) followed by FDG-Positron Emission Tomography (PET-FDG). VUS protocol includes the systematic assessment of the following artery territories: common carotid, proximal internal and external carotid, vertebral, subclavian, axillary and temporal. VUS was also used to assess for the presence of carotid atherosclerotic plaques. Patients with GCA were compared with a 38 Polymialgia Rheumatica (PMR) patients and 80 controls, matched for age and sex. GCA was also subclassified as Cranial (C-GCA, only cranial vessels involved), or Large-Vessel (LV-GCA when any degree of extracranial Large Arteries were involved).
Results: Patients with GCA included were diagnosed at age of 71 (65-79) years, 21/38 were male. GCA was newly diagnosed in 31 and relapsing in 7 patients at the time of VUS. Regarding disease phenotype, 27 (71%) of patients had LV-GCA and 11 (29%) had C-GCA. The occurrence of other cardiovascular risk factors was not different among groups, although there was a trend towards lower prevalence of diabetes mellitus among patients with GCA (Table 1). The prevalence of carotid atherosclerotic plaque in GCA patients was of 17/38 (45%), which was not different from PMR (53%, p=0,491) and from controls (59%, p=0,153). The presence of carotid plaques in C-GCA patients was of 9/11 (82%), whereas in LV-GCA was of 8/27 (30%, p=0,005). As shown in Table 2, C-GCA was more frequent in older age >75 years-old 6/11 (55%) and LV-GCA in younger ≤ 75 years-old 19/24 (79%), although without statistical significance (p=0,142).
Conclusion: In our study cohort, the prevalence of carotid atherosclerotic plaques was considerable in GCA and only slightly inferior to PMR and controls. There was an association between the GCA phenotype and the presence of carotid plaques, but not with the age at diagnosis. These results should be validated in larger cohorts.
REFERENCES: [1] Prieto-González S, et al. Ann Rheum Dis. 2012; 71(7):1170-6.
[2] Förster S, et al. Vasa 2011; 40(3):219-27.
[3] Monti S, et al. Ann Rheum Dis. 2023; 82(8):1098-1106.
Comparison of GCA with PMR and controls---
| GCA | PMR | p-value | Controls | p-value | |
|---|---|---|---|---|---|
| n | 38 | 38 | 80 | ||
| Female | 17 (45%) | 15 (40%) | 0,642 | 43 (54%) | 0,432 |
| Age | 73 (67-79) | 75 (69-81) | 0,183 | 71 (65-79) | 0,689 |
| Age >75 years-old | 14 (37%) | 18 (47%) | 0,353 | 33 (41%) | 0,648 |
| Hypertension | 28 (74%) | 28 (74%) | 0,999 | 55 (69%) | 0,583 |
| Diabetes mellitus | 6 (16%) | 13 (34%) | 0,111 | 26 (33%) | 0,056 |
| Hyperlipidemia | 27 (71%) | 15 (40%) | 0,006 | 47 (59%) | 0,197 |
| Smoking | 10 (26%) | 6 (15%) | 0,188 | 19 (24%) | 0,624 |
| Previous MI | 1 (3%) | 5 (13%) | 0,200 | 9 (11%) | 0,164 |
| Previous stroke | 2 (5%) | 5 (13%) | 0,215 | 7 (9%) | 0,399 |
| Peripheral artery disease | 0 | 0 | - | 3 | 0,308 |
| Carotid IMT | 0,80 (0,70-1,00) | 0,70 (0,70-0,90) | 0,251 | 0,80 (0,70-0,90) | 0,230 |
| Carotid plaque | 17 (45%) | 20 (53%) | 0,491 | 47 (59%) | 0,153 |
Comparison between LV-GCA and C-GCA-
| LV-GCA | C-GCA | p-value | |
|---|---|---|---|
| n | 27 | 11 | |
| Female | 14 (52%) | 3 (27%) | 0,153 |
| Age | 70 (62-78) | 79 (69-83) | 0,154 |
| Age >75 years-old | 8 (30%) | 6 (55%) | 0,149 |
| Hypertension | 20 (74%) | 8 (73%) | 0,615 |
| Diabetes mellitus | 3 (11%) | 3 (27%) | 0,221 |
| Hyperlipidemia | 17 (63%) | 10 (90%) | 0,088 |
| Smoking | 8 (29%) | 2 (18%) | 0,837 |
| Carotid plaque | 8 (30% ) | 9 (82% ) | 0,005 |
Acknowledgements: NIL.
Disclosure of Interests: João Fernandes Serodio Novartis, Carolina Saca: None declared, Frederico Batista: None declared, Filipe Seguro Paula: None declared, Susana Oliveira: None declared, Jose Delgado Alves Novartis, Lilly, AbbVie.