Abstract Background and aims Giant cell arteritis (GCA) is associated with increased cardiovascular risk, but the spectrum of cardiovascular outcomes and their timing after diagnosis remain incompletely characterized. We aimed to estimate 5-year cardiovascular event and mortality risks in patients with GCA compared with matched controls and to explore associations with tocilizumab therapy. Methods We performed a retrospective propensity score-matched cohort study using the TrinetX US collaborative network. Patients aged ≥50 years with GCA and matched controls were followed for 5 years. Primary outcomes included major adverse cardiovascular events (MACE), heart failure, stroke, aortic aneurysm, and vision loss. Secondary analyses compared outcomes in GCA patients treated with vs. without tocilizumab. Results After propensity score matching, 15,618 GCA patients and 15,618 matched controls were included. Compared with controls, GCA patients had increased hazard ratios for MACE (1.18; 95% CI, 1.10—1.26), heart failure (1.18; 95% CI, 1.10—1.27), acute myocardial infarction (1.15; 95% CI, 1.04—1.26), and ischaemic stroke (1.34; 95% CI, 1.21—1.50). All-cause mortality did not differ significantly (HR, 1.02; 95% CI, 0.96—1.09). Highest risks were observed for vision loss (HR, 2.03; 95% CI, 1.85—2.23) and aortic aneurysm (HR, 1.59; 95% CI, 1.42—1.79). Among tocilizumab-treated patients (n = 853), absolute risk reductions of 4.1% for death, 4.0% for MACE, and 2.9% for heart failure were observed compared with untreated patients. Conclusions GCA is associated with frequent cardiovascular events within 5 years of diagnosis. Tocilizumab therapy may be protective against major adverse outcomes. Conflict of interest Nils Werring: nothing to disclose. Michelle Oswald: nothing to disclose. Elena Rakusa: nothing to disclose. Georg Royl received compensation from Cardinal Health 200 LLC for consultant services, compensation from Novartis Pharma AG for other services, compensation from AstraZeneca for consultant services, travel support from Boehringer Ingelheim, compensation from Boehringer Ingelheim for consultant services, compensation from Ipsen Pharma SAS for consultant services and compensation from Bristol-Myers Squibb for consultant services. Tobias Wagner-Altendorf: nothing to disclose. Jens Minnerup: nothing to disclose.
Werring et al. (2026) studied this question.