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Meta-Analysis
. 2020 Nov 20;99(47):e23009.
doi: 10.1097/MD.0000000000023009.

Systemic sclerosis and risk of cardiovascular disease: A PRISMA-compliant systemic review and meta-analysis of cohort studies

Xintao Cen  1 , Sining Feng  1 , Shanshan Wei  1 , Lu Yan  1 , Ledong Sun  1   2
Affiliations
Meta-Analysis

Systemic sclerosis and risk of cardiovascular disease: A PRISMA-compliant systemic review and meta-analysis of cohort studies

Xintao Cen et al. Medicine (Baltimore). .

Abstract

Background: Systemic sclerosis (SSc) is an autoimmune disorder leading to extensive fibrosis and microvascular injury. Macrovascular disease is well documented in other autoimmune rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis. However, the link is unclear between SSc and macrovascular disease, particularly atherosclerotic cardiovascular disease (CVD). This meta-analysis aimed to investigate the association between SSc and CVD.

Methods: A thorough literature search was conducted in the Cochrane, Embase, Medline, and PubMed to identify all cohort studies comparing the risk of CVD with and without SSc. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular end points were calculated. The risk of bias of included studies was assessed by the Newcastle-Ottawa scale.

Results: Seven cohort studies with a total of 14,813 study participants were included. In a comparison of SSc patients versus non-SSc controls, the pooled HR for cardiovascular disease was 2.36 (95% CI 1.97-2.81); for peripheral vascular disease was 5.27 (95%CI 4.27-6.51); for myocardial infarction was 2.36 (95% CI 1.71-3.25); and for stroke was 1.52 (95% CI 1.18-1.96).

Conclusion: This meta-analysis revealed that SSc was associated with an increased risk of CVD. Clinicians who manage patients with SSc should be aware of the increased cardiovascular burden and undertake preventive measures.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA study flow diagram.
Figure 2
Figure 2
Forest plots of the association of systemic sclerosis (SSc) with cardiovascular diseases. A, The association between SSc and risk of cardiovascular disease. B, The association between SSc and risk of peripheral vascular disease. C, The association between SSc and risk of myocardial infarction. D, The association between SSc and risk of stroke. A generic inverse-variance (IV) method was used to calculate the pooled hazard ratio (HR) with a random-effects meta-analysis model. Heterogeneity was assessed using the I2 statistics. SE = standard error, CI = confidence interval.
Figure 3
Figure 3
Risk of bias of the cohort studies. Risk of bias of cohort studies was assessed by the Newcastle-Ottawa scale. Green color represents low risk of bias, red for unclear risk of bias.
See this image and copyright information in PMC

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