AGE and hypertension are risk factors for cranial ischaemic complications in patients with giant cell arteritis (GCA), while anticoagulation therapy appears protective, according to recent research.
Researchers aimed to investigate whether pre-existing cardiovascular (CV) risk factors, CV disease, or genetic predispositions are associated with cranial ischaemic complications in patients with giant cell arteritis (GCA). GCA, a form of vasculitis, can lead to serious complications, including visual loss and stroke, due to cranial ischaemia. Previous research has suggested that age and other cardiovascular risk factors may influence the occurrence of these complications, so researchers sought to explore these associations in greater detail, including the potential protective role of anticoagulant therapy.
A cohort of 1946 patients with GCA was analysed, with a median age of 71 years. The presence of cranial ischaemic complications was assessed, and various CV-related traits, including polygenic risk scores (PRS) for CV traits, were tested for associations with these complications. Of the cohort, 17% had cranial ischaemic complications at presentation. Univariable analysis identified 10 variables significantly associated with complications, with anticoagulant therapy and age showing the strongest effects in multivariable analysis. Patients on anticoagulant therapy had a significantly lower risk of complications (adjusted OR: 0.21; p=0.005), while older patients (≥80 years) were at higher risk (adjusted OR: 1.60; p=0.002). Further analysis indicated hypertension was also a significant risk factor (adjusted OR: 1.35; p=0.03). Gene mapping of an associated transient ischaemic attack PRS highlighted TEK, CD96 and MROH9 loci as potential genetic influences.
This study confirms that age and hypertension are associated with a higher risk of cranial ischaemic complications in patients with GCA, while anticoagulant therapy may have a protective effect. These findings suggest a need for further research into therapeutic strategies targeting thrombosis pathways in GCA. Future clinical trials should explore the potential of anticoagulant therapy as a preventive measure for cranial ischaemic complications in this patient population. Additionally, genetic insights into immune and coagulation-related mechanisms may offer new targets for treatment.
Katrina Thornber, EMJ
Reference
Chaddock NJM et al. Age, anticoagulants, hypertension and cardiovascular genetic traits predict cranial ischaemic complications in patients with giant cell arteritis. Ann Rheum Dis. 2024;DOI:10.1136/ard-2024-225515.
