s36_ab1

Predictors of cerebrovascular accidents in giant cell arteritis in a defined population

R. Pego-Reigosa¹, C. Garcia-Porrua², A. Piñeiro², T. Dierssen³, J. Llorca³, M.A. Gonzalez-Gay²

Divisions of Neurology¹ and Rheumatology², Hospital Xeral-Calde, Lugo; Division of Preventive Medicine and Public Health³, School of Medicine, University of Cantabria, Santander, Spain.

ABSTRACT
Objective
To examine the frequency and predictors of cerebrovascular accidents (CVA) in giant cell arteritis (GCA) patients from a defined population.

Methods
Retrospective study of biop-syproven GCA patients diagnosed from 1981 through 2001 at the single hospital for the population of Lugo (Northwest Spain).

Results
Thirty (14.3%) of the 210 biopsy-proven GCA patients had CVA, 5 of them (16.7%) involving the verte-brobasilar territory. Five patients (4 of them involving the carotid territory) had CVA within the 2 years prior to the onset of GCA symptoms. Four patients had CVA within the first month after the diagnosis of the disease. Of these, 3 involved the vertebrobasilar territory. Another 5 patients suffered carotid stroke between the 4th and the 12th month after the disease diagnosis. The remaining 16 GCA patients had CVA (all but one involving the carotid territory) at least 1 year after the diagnosis of vasculitis. No differences in the clinical and laboratory features at the time of diagnosis between patients who had CVA and the rest of the biop-syproven GCA patients were observed. However, hypertension and hyper-lipidemia at the time of diagnosis of GCA were associated with the development of CVA (p <0.05 for both). Also, anemia at the time of diagnosis (hemoglobin < 12 g/dL) [hazard ratio = 0.34 {95% CI 0.12 - 1.00; p = 0.05}] was negatively associated with CVA within the first 10 years after the diag-nosis of the disease. Mortality in GCA patients with CVA was not significantly higher than that in patients without CVA (hazard ratio =1.53; p=0.14).

Conclusion
The present study con-firms that CVA may occur in GCA. Ver-tebrobasilar accidents are more common than carotid accidents at the time of diagnosis of the disease. Vascular risk factors should be carefully control-led in the follow-up of GCA patients.

Key words
Giant cell (temporal) arteritis, temporal artery biopsy, cerebrovascular accidents, vertebro-basilar, hypertension, hyperlipidemia, anemia.

Please address correspondence to: Dr. Miguel A. González-Gay, Division of Rheumatology, Hospital Xeral-Calde, c/ Dr. Ochoa s/n, 27004 Lugo, Spain.
E-mail: miguelaggay@hotmail.com