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Cardiovascular events risk in patients with systemic autoimmune diseases: a prognostic systematic review and meta-analysis

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Abstract

Background

Chronic inflammation is considered a risk factor for the development of atherosclerosis and cardiovascular (CV) events. We seek to assess the risk of CV events in patients with Systemic autoimmune diseases (SAD), such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Psoriasis (Ps) and Ankylosing Spondylitis (AS), compared with the general population.

Methods and results

A systematic search of MEDLINE from inception up to May 2021 was performed. Observational studies including individuals with and without autoimmune diseases (SLE, RA, Ps, AS), which reported a measure of association and variability for the effect of SAD on CV events, were included. The random effects meta-analysis was performed using the Hartung–Knapp–Sidik–Jonkman approach to obtain the pooled estimates. Cardiovascular Events including CV mortality, non-fatal myocardial infarction (MI), non-fatal stroke and coronary revascularization were the main outcomes evaluated.

Fifty-four studies were selected, with a total of 24,107,072 participants. The presence of SAD was associated with an increased risk of CV mortality (HR 1.49 [95% CI 1.10–2.03]), non-fatal MI (HR 1.42 [95% CI 1.23–1.62]), and non-fatal stroke (HR 1.47 [95% CI 1.28–1.70]). RA, SLE, and Ps (particularly with arthritis) were significantly associated with a higher risk of MI and stroke. SAD was also associated with an increased risk of Major Adverse Cardiovascular Events (MACE) (HR 1.45 [95% CI 1.16–1.83]).

Conclusion

Patients with SAD present an increased risk of CV morbidity and mortality, which should be considered when establishing therapeutic strategies. These findings support the role of systemic inflammation in the development of atherosclerosis-driven disease.

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Acknowledgements

This works by supported by Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT) de la Agencia Nacional de Investigación y Desarrollo (ANID), Chile—Proyecto FONDECYT Regular Nº 1210655 and Agencia Nacional de Investigación y Desarrollo (ANID), Programa Iniciativa Científica Milenio, Chile – Nº ICN2021_004.

Funding

Agencia Nacional de Investigación y Desarrollo, FONDECYT Regular Nº 1210655, Gonzalo Martinez, Programa Iniciativa Científica Milenio, Leticia Gonzalez, Chile – Nº ICN2021_004, Leticia Gonzalez.

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Authors and Affiliations

  1. Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana Universidad de Desarrollo, Santiago, Chile

    Claudia Asenjo-Lobos & Paula Muñoz Venturelli

  2. Centro de Imágenes Biomédicas, Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Leticia González

  3. Instituto Milenio de Ingeniería e Inteligencia Artificial para la Salud, iHEALTH, Pontificia Universidad Católica de Chile, Santiago, Chile

    Leticia González

  4. División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile

    Juan Francisco Bulnes & Gonzalo Martínez Rodríguez

  5. Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain

    Marta Roque

  6. Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia

    Paula Muñoz Venturelli

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  1. Claudia Asenjo-Lobos
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  2. Leticia González
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Correspondence to Gonzalo Martínez Rodríguez.

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Asenjo-Lobos, C., González, L., Bulnes, J.F. et al. Cardiovascular events risk in patients with systemic autoimmune diseases: a prognostic systematic review and meta-analysis. Clin Res Cardiol 113, 246–259 (2024). https://doi.org/10.1007/s00392-023-02291-4

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