Raised LDL cholesterol, hsCRP tied to polymyalgia rheumatica, GCA

June 7, 2018|Family Medicine

REPORTING FROM BSR 2018

LIVERPOOL, ENGLAND – The presence of traditional cardiovascular risk factors may precede the development of polymyalgia rheumatica and giant cell arteritis.

Data from the EPIC-Norfolk study, reported at the British Society for Rheumatology annual conference, showed that raised LDL cholesterol was associated with the onset of polymyalgia rheumatica (PMR) and that high sensitivity C-reactive protein (hsCRP) was associated with giant cell arteritis (GCA).

Cox proportional hazard modeling adjusted with competing risk for death showed that an LDL cholesterol level of 4.1 mmol/L or higher at baseline was associated with an almost 30% increased risk of later being diagnosed with PMR (subhazard ratio, 1.29; 95% confidence interval, 1.01-1.64; P = .043). Raised hsCRP (greater than 2.6 mg/dL) increased the risk of subsequent GCA by 85% (SHR, 1.85; 95% CI, 1.09-3.14; P = .022). Being female was also significantly linked with the development of both PMR and GCA (SHRs, 2.64 and 2.61, respectively).

“There’s been an association between vascular disease and PMR and GCA reported, but the way cardiovascular disease has been defined has been based on rather late endpoints, such as angina, myocardial infarction, peripheral vascular disease, and ischemia,” said Max Yates, MBBS, MRCP, in an interview.

“So, what we wanted to do was look at underlying risk factors for those diseases and see how they play in, in terms of the timing of the diagnosis of PMR and GCA,” he explained. Dr. Yates, who is a National Institute for Health Research clinical lecturer in rheumatology at the University of East Anglia, Norwich, England, noted that this was probably the first prospective study to look at clinical and laboratory parameters for vascular disease prior to the onset of these diseases.

Previously, French researchers suggested that there might be a link between hypertension and subsequent PMR, but that was a descriptive study published over 30 years ago, Dr. Yates said. “There was another case-control study from the Mayo Clinic where they said that smoking was associated with incidence GCA,” he added. “So most of the work has been retrospective, case-control studies.”

The EPIC (European Prospective Investigation of Cancer)-Norfolk study is a large, prospective, community-based cohort study that, as its name might suggest, was originally set up to look at risk factors for cancer. Since then it has broadened to enable the study of risk factors for a whole host of other conditions.