Glucocorticoid prescribing and cardiovascular risk in polymyalgia rheumatica and giant cell arteritis: analysis of routinely collected primary care data from the North of England

Objectives Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are treated with long-term glucocorticoid therapy, which may increase the risk of cardiovascular disease (CVD). Patients with established CVD or with a 10-year CVD risk ≥10%, as estimated by the QRISK tool in primary care, should be offered statins. We aimed to characterise glucocorticoid prescribing and cardiovascular risk in a new primary care PMR/GCA cohort, using the Connected Bradford database. Methods We identified patients aged ≥50 years with a new diagnosis of PMR/GCA between 1st January 2000 and 31st December 2023, registered with a GP practice contributing to Connected Bradford for >6 months and with ≥2 glucocorticoid prescriptions post-diagnosis. Average cumulative prednisolone equivalent dose was calculated in 13-week blocks over a four-year follow-up period. To characterise CVD risk, prevalence of diabetes mellitus, atrial fibrillation, heart failure, peripheral arterial disease, hypertension and median QRISK3 scores were estimated on the date of PMR/GCA diagnosis. Results 4,105 patients with PMR and 700 with GCA were identified (66.5% female; mean age 73.6 years). Incidence was 6.27/10,000 person-years for PMR and 1.07/10,000 person-years for GCA. Over a third of the cohort were still prescribed glucocorticoids two years after PMR/GCA diagnosis. At cohort entry, median QRISK3 score was 29.5%, and 25.3% had pre-existing cardiovascular or cerebrovascular disease. Conclusion There was a considerable burden of CVD, reflected in high QRISK3 scores, alongside frequent prolonged glucocorticoid exposure, translating known excess cardiovascular risk in PMR/GCA into guideline-actionable clinical burden.