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Meta-Analysis
. 2020 Sep;6(2):e001247.
doi: 10.1136/rmdopen-2020-001247.

Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis

Jinoos Yazdany  1 , Nick Pooley  2 , Julia Langham  3 , Lindsay Nicholson  2 , Sue Langham  4 , Nina Embleton  5 , Xia Wang  6 , Barnabas Desta  7 , Volkan Barut  8 , Edward Hammond  9
Affiliations
Meta-Analysis

Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis

Jinoos Yazdany et al. RMD Open. 2020 Sep.

Abstract

Objective: To evaluate the risk of stroke and myocardial infarction (MI) in adult patients with systemic lupus erythematosus (SLE) through a systematic review and meta-analysis.

Methods: We searched MEDLINE and EMBASE from inception to May 2020 to identify observational studies (cohort and cross-sectional) that evaluated risk of stroke and MI in adult patients with SLE compared with the general population or healthy controls. Studies were included if they reported effect-size estimates that could be used for calculating pooled-effect estimates. Random-effects models were used to calculate pooled risk ratios (RRs) and 95% CIs for stroke and MI. Heterogeneity quantified by the I2 test and sensitivity analyses assessed bias.

Results: In total, 26 studies were included in this meta-analysis: 14, 5 and 7 studies on stroke, MI and both stroke and MI, respectively. The pooled RR for ischaemic stroke was 2.18 (95% CI 1.78 to 2.67; I2 75%), intracerebral haemorrhage 1.84 (95% CI 1.16 to 2.90; I2 67%), subarachnoid haemorrhage 1.95 (95% CI 0.69 to 5.52; I2 94%), composite stroke 2.13 (95% CI 1.73 to 2.61; I2 88%) and MI 2.99 (95% CI 2.34 to 3.82; I2 85%). There was no evidence for publication bias, and sensitivity analyses confirmed the robustness of the results.

Conclusions: Overall, patients with SLE were identified to have a twofold to threefold higher risk of stroke and MI. Future research on the interaction between known SLE-specific modifiable risk factors and risk of stroke and MI to support development of prevention and treatment strategies are needed.

Prospero registration number: CRD42018098690.

Keywords: Cardiovascular Disease; Epidemiology; Outcomes research; Systemic Lupus Erythematosus.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare that NP, JL, LN, SL and NE have received personal fees from AstraZeneca during the conduct of the study and outside the submitted work. VB, XW, BD and EH are employees of AstraZeneca.

Figures

Figure 1
Figure 1
Flow diagram of the systematic literature review process to evaluate the risk of stroke and MI in patients with SLE compared with the general population or healthy controls. MI, myocardial infarction; SLE, systemic lupus erythematosus.
Figure 2
Figure 2
Forest plots of pooled risk ratios for stroke and MI outcomes in adult patients with SLE compared with the general population or healthy controls: (A) composite stroke, (B) subarachnoid haemorrhage, (C) intracerebral haemorrhage, (D) ischaemic stroke, (E) MI. MI, myocardial infarction; SLE, systemic lupus erythematosus.
See this image and copyright information in PMC

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