Polymyalgia Rheumatica Increases Heart Attack, Stroke Risk

Jenni Laidman

July 28, 2014

Patients with polymyalgia rheumatica (PMR) are at 2.5 times the risk for a vascular event than matched control patients, with the greatest risk occurring in patients younger than 60 years, according to a study published online July 28 in CMAJ.

Adam T. Hancock, MBChB, MPhil, from the Arthritis Research UK Primary Care Centre, Keele University, United Kingdom, and colleagues identified 3249 patients with PMR and compared them with 12,735 control patients without the disease, but matched for age, sex, and practice, to determine whether PMR, similar to other inflammatory rheumatologic disorders, was associated with a higher incidence of vascular events. The researchers followed-up patients until their first vascular event — cardiovascular, cerebrovascular, or peripheral vascular — or until the end of available records in May 2011. The patients and control participants were identified in the General Practice Research Database, a UK electronic database for primary care records.

The researchers adjusted for age, sex, and known vascular risk factors. The risk for vascular events was higher among patients with PMR than among those without the disease, for an adjusted hazard ratio (AHR) of 2.6 (95% confidence interval [CI], 2.4 - 2.9). Among patients with PMR, there were 36.1 vascular events per 1000 person-years vs 12.2 events per 1000 person-years for those without the disease.

The authors say the results should heighten attention to vascular risk factors among these patients. "Our findings suggest an increased risk of vascular events in patients with [PMR], independent of other traditional risk factors for vascular disease. Aggressive management of vascular risk factors should be considered in patients with [PMR] to try to attenuate this excess risk," they write.

The research uncovered associations between PMR and cerebrovascular events (AHR, 2.3; 95% CI, 2.0 - 2.6), cardiovascular events (AHR, 2.7; 95% CI, 2.4 - 3.0), and peripheral vascular events (AHR, 2.8; 95% CI, 2.2 - 3.5). The risk for cerebrovascular and cardiovascular events was highest within the first 6 to 12 months of a PMR diagnosis. Patients aged 50 to 59 years had a more than 5-fold increased risk for a vascular event. Patients aged 80 years and older had a 3-fold increased risk.

PMR is among the most common inflammatory rheumatologic disorders in the elderly, with a lifetime risk of 2.4% in women and 1.7% in men.

The authors suggest several potential mechanisms for an association between PMR and vascular disease, including the disease's inflammatory burden, the association of PMR with giant cell arteritis, and the effects of long-term corticosteroid use, including diabetes, hypertension, and dyslipidemia, although they also note that corticosteroids could protect against vascular events by controlling inflammation.

The authors have disclosed no relevant financial relationships.

CMAJ. Published online July 28, 2014. Full text

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