Is there a correlation between temporal arteritis and coronary artery disease (CAD)?

Temporal Arteritis and Coronary Artery Disease: No Direct Correlation Established

There is no established direct correlation between temporal arteritis (giant cell arteritis) and coronary artery disease (CAD) based on current guideline evidence. While both conditions can coexist in elderly patients who share common atherosclerotic risk factors, temporal arteritis primarily affects medium and large elastic vessels—particularly cranial arteries and the aorta with its major branches—rather than the coronary circulation 1.

Distinct Vascular Territories

Temporal arteritis targets specific vessel types that typically exclude coronary arteries:

• Giant cell arteritis involves elastic vessels, specifically the aorta and its secondary and tertiary branches, with predilection for cranial arteries 1
• Medium-sized vessels affected by temporal arteritis include conduit muscular arteries and their branches, but coronary arteries are not characteristically involved 1
• The disease affects patients above age 50 years with peak incidence in the eighth decade, affecting women in a 3:2 ratio to men 1

Clinical Manifestations Do Not Include Cardiac Ischemia

The ischemic complications of temporal arteritis are confined to non-coronary territories:

• Common ischemic complications include vision loss (14-18% of patients), stroke, cranial nerve palsy, and scalp necrosis 1, 2
• Large-vessel complications involve aneurysms and stenoses of the aorta and its major branches, not coronary vessels 1
• Jaw claudication occurs in approximately 50% of patients, but this reflects external carotid artery involvement, not coronary insufficiency 1

Shared Risk Factors vs. Direct Association

The coexistence of temporal arteritis and CAD in elderly patients reflects shared demographics rather than pathophysiological linkage:

• Both conditions affect older adults who may have traditional atherosclerotic risk factors (hypertension, hyperlipidemia, diabetes) 1
• The presence of extracardiac vascular disease (carotid, aortic, or peripheral) is a risk factor for poor outcomes in patients with acute coronary syndromes, but this refers to atherosclerotic disease, not vasculitis 1
• Age itself is the strongest independent risk factor for both CAD and temporal arteritis, but through different mechanisms 1

Important Clinical Caveats

When evaluating elderly patients with chest symptoms, distinguish inflammatory vasculitis from atherosclerotic disease:

• Temporal arteritis presents with constitutional symptoms (fever, weight loss, malaise), elevated inflammatory markers (ESR >40 mm/h, elevated CRP), and cranial symptoms—not angina 1, 2
• Thrombocytosis (platelet count >400 × 10³/μL) is common in temporal arteritis and may occur in 44% of patients, but this does not correlate with ischemic cardiac complications 2, 3
• If a patient with known temporal arteritis develops chest pain, evaluate for typical atherosclerotic CAD using standard diagnostic approaches, as the vasculitis does not explain coronary symptoms 1

Diagnostic Approach

Temporal artery biopsy remains the gold standard for diagnosis and does not provide information about coronary involvement:

• A long-segment temporal artery biopsy (>1 cm) should be obtained within 2 weeks of starting glucocorticoids 1
• Histopathological findings include arterial wall thickening, mononuclear inflammatory infiltrate with media invasion, and multinucleated giant cells 1, 2
• The absence of coronary artery involvement in the pathophysiology means temporal artery biopsy findings do not predict CAD risk 1