Patients with Giant Cell Arteritis at Twofold Greater Risk of Aortic Aneurysms

Researchers advise clinicians to consider including thoracic aortic evaluations in the routine care of patients with GCA due to their significantly elevated risk of developing the life-threatening complication. Photo: Trenton Cleghern, OD. Click image to enlarge. In addition to ophthalmic involvement, including potential blindness, the systemic autoimmune disease giant cell arteritis (GCA) can also damage the aorta and its primary branches. As a result, instances of aortic aneurysm (AA) and carotid artery stenosis have been reported among this population. A recent study analyzing the risk of these two conditions in GCA patients with and without visual symptoms found that while these individuals are substantially more likely to develop AA or carotid artery stenosis, presenting with vision changes showed no correlation with additional aortic risk. The retrospective cohort study, published in American Journal of Ophthalmology, included 7,294 patients aged ≥50 years with biopsy-confirmed GCA who were matched and compared to an equal number of control patients presenting with tension-type headache, identified through the TriNetX network. The researchers also performed a secondary analysis to compare GCA patients with (n=2,390) and without (n=5,222) visual symptoms, such as diplopia, amaurosis fugax and vision loss. The findings revealed that GCA patients had a significantly greater five-year risk of developing any aortic aneurysm (3.6% vs. 1.8% for controls), including thoracic (2.2% vs. 1.0%), thoracoabdominal (0.3% vs. 0.1%) and abdominal (1.8% vs. 0.8%). Carotid artery stenosis was also more common in patients with GCA (7.2% vs. 4.4% for controls).In the subanalysis of GCA patients with and without visual symptoms, the five-year risk of any aortic aneurysm was comparable between the two groups (3.6% vs. 3.2%); however, patients with visual symptoms did show a higher prevalence of carotid artery stenosis (8.95% vs.7.43%).Several studies in the literature back up the finding of increased AA risk in GCA patients, the researchers noted in their paper. “GCA is a large-vessel vasculitis and patients are at risk of aortic structural damage commonly due to aortitis,” they wrote. “CT studies have revealed aortic thickening (presumed aortitis) in 45% to 65% of patients with GCA at diagnosis.” They noted that in one previous study reporting “a more frequent aortic dilation in the ascending aorta while aortitis was more prominent in the descending aorta,” the authors postulate that “a stiff descending aorta might act as a functional coarctation and the ascending aorta [that is subject to high pressure and hemodynamic factors] may undergo progressive dilation.” Another prior work agreed that the “high prevalence of thoracic aortic aneurysms in patients with GCA may be due to abnormal vascular remodeling of the aortic wall, with hemodynamic factors playing a greater role in the ascending portion where mechanical forces are higher.”Less is known about this study’s observation of an increased risk of carotid artery stenosis in GCA patients who present with visual symptoms, which the authors note “is an intriguing phenomenon that warrants careful consideration.” Prior investigations have hinted at a lower systemic inflammatory response in GCA patients presenting with vision changes, leading the authors to speculate that “the presence of visual symptoms may act as a clinical indicator of low-grade chronic inflammation and widespread vascular involvement that could promote the development of carotid artery stenosis.” Given that aortic aneurysms are potentially life-threatening, the authors of the study conclude by advising that “it would be beneficial for clinicians to consider including thoracic aortic evaluations with CTA, MRA and/or FDG-PET as well as carotid ultrasound into the routine care of GCA patients, especially for those presenting with visual symptoms.”Click here for the journal source. Chacko JA, Chauhan MZ, Phillips PH, Ramakrishnaiah RH, Chacko JG. Aortic and carotid complications in patients with giant cell arteritis. Am J Ophthalmol. June 2025. [Epub ahead of print].