Risk factors for acute coronary syndrome in patients with giant cell arteritis: a scoping review

Background Giant cell arteritis (GCA) is a chronic inflammatory vasculopathy associated with an increased risk of cardiovascular and thromboembolic complications, including acute coronary syndrome (ACS). Early identification of high-risk subgroups is essential for targeted prevention. This scoping review summarizes the demographic and clinical characteristics of patients with GCA who are at elevated risk for ischemic cardiac events.

Design Scoping review.

Methods We systematically searched PubMed, Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), and EMBASE (Ovid interface) for studies evaluating the association between GCA and ACS, applying predefined eligibility criteria. Eligible studies included adults aged ⩾50 years with confirmed GCA and reported ACS outcomes. Data were synthesized qualitatively, and key quantitative variables were extracted.

Results Nine studies met inclusion criteria, encompassing 14,484 patients with GCA. Of these, 71.5% were women, 77% had a new GCA diagnosis, and 9.8% experienced an ischemic cardiac event during follow-up. Consistently reported predictors of ACS included the early post diagnosis period, male sex, and older age at diagnosis. Other potential risk factors such as hypertension, corticosteroid use, and concomitant polymyalgia rheumatica were inconsistently reported or lacked statistical significance. Substantial heterogeneity in study design, definitions, and follow-up duration precluded pooled analysis.

Conclusion Older age, male sex, and the period shortly after GCA diagnosis appear to confer the highest risk for ACS, though current evidence is limited by methodological variability and incomplete reporting. Prospective studies with standardized definitions, detailed treatment data, and longitudinal follow up are needed to refine cardiovascular risk stratification in GCA. Meanwhile, clinicians should maintain heightened vigilance for cardiac events in high-risk patients, particularly early in the disease course.