Age, Hypertension Identified as Risk Factors for Cranial Ischemic Complications in GCA

Age, anticoagulant use, hypertension, and genetic cardiovascular (CV) traits may predict the risk for cranial ischemic complications among patients with giant cell arteritis (GCA), according to results of a large cohort study published in Annals of the Rheumatic Diseases.

Identifying predictors of cranial ischemic complications at GCA diagnosis could help clinicians implement more personalized management strategies. Thus, researchers used polygenic risk scores and positional gene mapping to investigate associations between pre-existing CV traits, medication use, and genetic risk factors with cranial ischemic complications at GCA presentation.

Data from 1946 patients with GCA involved in the UK GCA Consortium sample were included in the analysis; 1844 individuals had complete genetic data. Among the total cohort, patients were aged a median of 71 years at diagnosis, 68.7% were women, and 99.2% were White European.

Overall, 17% of patients experienced cranial ischemic complications at the time of GCA diagnosis, 59.3% displayed transient cranial ischemic manifestations, and 12.5% had extracranial ischemic features.

Results of multivariable analyses revealed that age at GCA diagnosis was a strong independent predictor of cranial ischemic complications. Specifically, patients aged at least 80 years were associated with significantly greater risks compared with those aged 60 years or less (adjusted odds ratio [aOR], 1.60; 95% CI, 0.73-3.66; P =.0025). Hypertension was also identified as a risk factor when anticoagulant use was excluded from analyses (aOR, 1.35; 95% CI, 1.03-1.75; P =.03). Anticoagulant therapy demonstrated protective effects, reducing the odds for cranial ischemic complications by over 75% (aOR, 0.21; 95% CI, 0.05-0.62; P =.0049).

Genetic analyses provided additional insights, identifying associations between polygenic risk scores for transient ischemic attacks and cranial ischemic complications  (P =.03).

Positional gene mapping highlighted immune and coagulation-related pathways, including the TEK and PLG gene loci, which are involved in vascular homeostasis and fibrin clot breakdown. These findings underscore the role of thrombotic and inflammatory mechanisms in the pathogenesis of cranial ischemic complications.

Moreover, results of sex-stratified analyses suggested that age and anticoagulant therapy were particularly significant predictors among women, highlighting the need for further investigation into sex-specific risk factors in GCA.

Study limitations include the predominantly White cohort and the lack of confirmatory diagnostic testing among some patients.

“Together, these results suggest a need for further interrogation of the role of thrombosis in GCA, and to elucidate whether anticoagulant therapy alongside glucocorticoids might be beneficial in patients with GCA, especially those with transient or monocular visual involvement, or other high-risk subsets,” the study authors concluded.

This article originally appeared on Rheumatology Advisor