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Myocardial infarction in giant cell arteritis: It is all a matter of balance.

      Patients with giant cell arteritis (GCA) represent an extremely fragile population. This frailty arises from the combination of a chronic, highly inflammatory disease affecting patients invariably older than 50 years of age and long-term use of drugs with extensive metabolic side effects such as glucocorticoids [
      • Salvarani C.
      • Cantini F.
      • Hunder G.G.
      Polymyalgia rheumatica and giant-cell arteritis.
      ,
      • Albrecht K.
      • Huscher D.
      • Buttgereit F.
      • Aringer M.
      • Hoese G.
      • Ochs W.
      • et al.
      Long-term glucocorticoid treatment in patients with polymyalgia rheumatica, giant cell arteritis, or both diseases: results from a national rheumatology database.
      ]. For this reason, management of GCA patients should not only aim at the symptomatic treatment of inflammatory manifestations and the prevention of short and long-term disease-related complications (i.e., sight loss, aortic aneurysms) [
      • Patil P.
      • Williams M.
      • Maw W.W.
      • Achilleos K.
      • Elsideeg S.
      • Dejaco C.
      • et al.
      Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study.
      ,
      • Jud P.
      • Verheyen N.
      • Dejaco C.
      • Haas E.
      • Szolar D.
      • Meinitzer A.
      • et al.
      Prevalence and prognostic factors for aortic dilatation in giant cell arteritis – a longitudinal study.
      ], but should always be weighted in order to minimize the potential treatment-related adverse events. It is now well established that GCA carries an increased risk of osteoporosis, type II diabetes mellitus, and severe infections, but also of cerebrovascular and cardiovascular complications [
      • Paskins Z.
      • Whittle R.
      • Sultan A.A.
      • Muller S.
      • Blagojevic-Bucknall M.
      • Helliwell T.
      • et al.
      Risk of fracture among patients with polymyalgia rheumatica and giant cell arteritis: a population-based study.
      ,
      • Faurschou M.
      • Ahlstrom M.G.
      • Lindhardsen J.
      • Obel N.
      • Baslund B.
      Risk of diabetes mellitus among patients diagnosed with giant cell arteritis or granulomatosis with polyangiitis: comparison with the general population.
      ,
      • Schmidt J.
      • Smail A.
      • Roche B.
      • Gay P.
      • Salle V.
      • Pellet H.
      • et al.
      Incidence of severe infections and infection-related mortality during the course of giant cell arteritis: a multicenter, prospective, double-cohort study.
      ,
      • Samson M.
      • Jacquin A.
      • Audia S.
      • Daubail B.
      • Devilliers H.
      • Petrella T.
      • et al.
      Stroke associated with giant cell arteritis: a population-based study.
      ]. Although the incidence of cardiovascular events (particularly, of myocardial infarction (MI)) in GCA patients has been already extensively reported by different groups to be higher than in the general population [
      • Amiri N.
      • De Vera M.
      • Choi H.K.
      • Sayre E.C.
      • Avina-Zubieta J.A
      Increased risk of cardiovascular disease in giant cell arteritis: a general population-based study.
      ,
      • Li L.
      • Neogi T.
      • Jick S.
      Giant cell arteritis and vascular disease-risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink.
      ,
      • Tomasson G.
      • Peloquin C.
      • Mohammad A.
      • Love T.J.
      • Zhang Y.
      • Choi H.K.
      • et al.
      Risk for cardiovascular disease early and late after a diagnosis of giant-cell arteritis: a cohort study.
      ,
      • Udayakumar P.D.
      • Chandran A.K.
      • Crowson C.S.
      • Warrington K.J.
      • Matteson E.L.
      Cardiovascular risk and acute coronary syndrome in giant cell arteritis: a population-based retrospective cohort study.
      ], a characterization of the features of MI in this group of patients was missing.

      Keywords

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      Linked Article

      • Myocardial infarction during giant cell arteritis: A cohort study
        European Journal of Internal MedicineVol. 89
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          Giant cell arteritis (GCA) is the most frequent vasculitis in adults over 50 years. It is a granulomatous large-vessel vasculitis mainly involving the aorta and cranial arteries [1–3]. Clinical signs of GCA include nonspecific symptoms related to systemic inflammation such as asthenia and fever, and ischemic symptoms that are triggered by vascular remodeling of the affected arteries, leading to arterial stenosis [4] and ischemic complications such as headache, anterior ischemic optic neuropathy or stroke [5–7].
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