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Meta-Analysis
. 2011 Jul;63(7):2078-90.
doi: 10.1002/art.30380.

Atherosclerosis in systemic sclerosis: a systematic review and meta-analysis

Karen Au  1 , Manjit K Singh, Vijay Bodukam, Sangmee Bae, Paul Maranian, Rikke Ogawa, Brennan Spiegel, Maureen McMahon, Bevra Hahn, Dinesh Khanna
Affiliations
Meta-Analysis

Atherosclerosis in systemic sclerosis: a systematic review and meta-analysis

Karen Au et al. Arthritis Rheum. 2011 Jul.

Abstract

Objective: Systemic sclerosis (SSc) is characterized by calcification, vasculopathy, and endothelial wall damage, all of which can increase the risk of developing atherosclerosis and cardiovascular disease. The aim of this study was to perform a systematic review and meta-analysis to determine whether the risk of atherosclerosis is increased in SSc patients compared to healthy individuals.

Methods: A systematic search was performed to identify studies published in PubMed and the Cochrane database up to May 2010, and recently published abstracts were also reviewed. Two reviewers independently screened articles to identify studies comparing the rate of atherosclerosis in SSc patients to that in healthy controls. The studies utilized one of the following methods: angiography, Doppler ultrasound to assess plaque and carotid intima-media thickness (IMT), computed tomography, magnetic resonance imaging, flow-mediated vasodilation (assessed as the FMD%), the ankle-brachial index, or autopsy. For carotid IMT and FMD% values, we computed a pooled estimate of the summary mean difference and explored predictors of carotid IMT using random-effects meta-regression.

Results: Of the 3,156 articles initially identified, 31 were selected for systematic review. The meta-analysis included 14 studies assessing carotid IMT and 7 assessing brachial artery FMD%. Compared to healthy controls, SSc patients had a higher prevalence of coronary atherosclerosis, peripheral vascular disease, and cerebrovascular calcification. Meta-analysis showed that SSc patients had increased carotid IMT (summary mean difference 0.11 mm, 95% confidence interval [95% CI] 0.05 mm, 0.17 mm; P = 0.0006) and lower FMD% (summary mean difference -3.07%, 95% CI -5.44%, -0.69%; P = 0.01) compared to controls. There was marked heterogeneity between the studies, which was mainly attributable to variations in disease duration and differences in the mean/median age between SSc patients and controls.

Conclusion: Patients with SSc have an increased risk of atherosclerosis compared to healthy subjects. Further studies should elucidate the mechanism of this increased risk.

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Figures

Figure 1
Figure 1
Flowchart of selected articles. 12 articles (Cheng, et al.) used the same CIMT data and 1 was excluded.
Figure 2
Figure 2
Meta-analysis showing the summary mean difference in carotid intima-medial thickness (CIMT) between SSc and control subjects (random-effects model).
Figure 3
Figure 3
Funnel plot of inverse standard error of the mean difference in CIMT between SSc subjects and controls under fixed effects model for meta-analysis. Pooled fixed effect estimate and 95% confidence bands are provided.
Figure 4
Figure 4
Meta-analysis showing the summary mean difference in flow mediated dilation (FMD) between SSc and control subjects (random-effects model).
See this image and copyright information in PMC

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