REVIEW - Rheumatic disease and carotid intima-media thickness: a systematic review and meta-analysis

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Arterioscler Thromb Vasc Biol. 2010 Feb 11.

Rheumatic Disease and Carotid Intima-Media Thickness. A Systematic

Review and Meta-Analysis.

Tyrrell PN, Beyene J, Feldman BM, McCrindle BW, Silverman ED, Bradley TJ.

Division of Rheumatology, The Hospital for Sick Children, Toronto,

Ontario, Canada; the Child Health Evaluative Sciences Program, The

Hospital for Sick Children, Toronto, Ontario, Canada; the Departments

of Health Policy, Management and Evaluation, University of Toronto,

Toronto, Ontario, Canada; the Dala Lana School of Public Health,

University of Toronto, Toronto, Ontario, Canada; the Department of

Pediatrics, University of Toronto, Toronto, Ontario, Canada; the

Division of Cardiology, The Hospital for Sick Children, Toronto,

Ontario, Canada; and the Department of Immunology, University of

Toronto, Toronto, Ontario, Canada.

OBJECTIVE: To perform a systematic review and meta-analysis to examine

whether rheumatic disease is associated with an increased carotid

intima-media thickness (CIMT; increasingly used as a surrogate marker

for atherosclerosis) when compared with healthy control subjects.

METHODS AND RESULTS: A prespecified search strategy was used to

identify relevant studies in the MEDLINE and EMBASE databases (January

1986 to December 2008). Methodological quality was assessed using the

Newcastle-Ottawa score for observational studies. A total of 68

controlled comparisons from 60 different studies were reviewed: 37% on

rheumatoid arthritis, 35% on systemic lupus erythematosus, 9% on

systemic sclerosis, and 19% on other rheumatic diseases.

Random-effects meta-regression analysis was performed. The estimated

summary effect size between control and study subject CIMT measurement

comparisons, with preexisting cardiovascular disease excluded, was

0.64 (95% CI, 0.46 to 0.82). This represented an overall absolute mean

difference of 0.055 mm (95% CI, 0.048 to 0.063 mm). Preexisting

cardiovascular disease, rheumatic disease type, and disease duration

contributed to heterogeneity.

CONCLUSIONS: Accelerated atherosclerosis is a common complication of

autoimmune rheumatic diseases, with early changes seen even in

pediatric patients. CIMT was significantly increased in rheumatic

disease populations. Future studies need to use a standardized

protocol to ensure clinically meaningful results when measuring CIMT

as a surrogate for premature atherosclerosis.

PMID: 20150560

http://www.ncbi.nlm.nih.gov/pubmed/20150560

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