Polymyalgia Rheumatica, Giant Cell Arteritis, and 12 CV Diseases
Is there an association of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) with cardiovascular diseases (CVDs)?
The authors used CALIBER (CArdiovascular disease research using LInked Bespoke studies and Electronic health Records) data, which links primary care and hospital and mortality data in England, from 1997 to 2010. They selected a cohort of men and women initially free from CVD at baseline and included all patients with PMR and/or GCA (PMR/GCA) diagnosis. Cohorts with PMR/GCA were matched by age, sex, and general practice with up to 10 individuals without PMR/GCA. Random effects Poisson regression analysis was used to study the association between PMR/GCA and the initial presentation of 12 types of CVDs (coronary diseases, heart failure, sudden death, cerebral and peripheral vascular disease, and abdominal aortic aneurysm).
The analysis included 9,776 patients with PMR only, 1,164 with GCA only, 627 with PMR and GCA, and 105,504 without either condition. Over 40% of patients with PMR/GCA received blood pressure-lowering medication, 10% statins, and 9% antiplatelet therapy. During a median of 3.14 years of follow-up, 24.1% of those with PMR/GCA and 20.4% without the inflammatory disorders developed CVDs. Patients with PMR/GCA had lower rates of sudden death (adjusted incidence ratio, 0.79; 95% confidence interval [CI], 0.66-0.95), transient ischemic attack (0.67; 95% CI, 0.54-0.84), and coronary and death composite (0.90; 95% CI, 0.82-0.98). No associations were observed for other CVDs or cerebrovascular diseases, and in patients with only PMR or GCA. No evidence of interaction by age or sex was found. Estimates decreased with longer PMR/GCA duration and findings were robust to multiple sensitivity analyses.
In this large contemporary population-based cohort, the presence of PMR and/or GCA was not associated with an increased risk of CVDs or cerebrovascular diseases regardless of PMR/GCA duration.
There is evidence of an increase in CVDs in connective tissue diseases including lupus and rheumatoid arthritis. Considering the inflammatory process and common association with arteritis, it is surprising there was no association in this large longitudinal study of PMR and GCA and CVD. The authors suggest it might be related to the long-term use of low-dose steroids, which reduced the inflammation.
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