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The risk of ischemic stroke in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis

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Abstract

Objective

Idiopathic inflammatory myopathies (IIM) are a group of chronic rheumatic diseases that can affect multiple systems; the risk of ischemic stroke in patients with IIM remains controversial. We aimed to systematically evaluate the risk of ischemic stroke in IIMs.

Methods

The PubMed, Embase, and Cochrane library were searched for relevant studies. Pooled relative risk (RR) with a 95% confidence interval (CI) was calculated as effect size to evaluate the risk of ischemic stroke in patients with IIM. Random effects model was chosen when I2 > 50%. We pooled all studies in a first total analysis to assess the risk of ischemic stroke in IIM. Subgroup analyses were conducted based on the subtypes of IIM (dermatomyositis) and country. Sensitivity analysis was performed to identify the heterogeneity sources.

Results

A total of 6 studies with 5,114 IIM cases and 14,516,099 controls were included, and the results demonstrated that IIMs were associated with an increased risk of ischemic stroke (RR = 2.41, 95% CI: 1.31, 4.45). Subgroup analysis indicated that patients with dermatomyositis (DM) had a 49% excess risk of ischemic stroke than controls; Asian patients with IIM had an increased risk of ischemic stroke, although not for American patients.

Conclusion

IIMs, especially patients with DM, are associated with an increased risk of ischemic stroke. Appropriate intervention may be taken into account for patients with IIM, especially when accompanied by other traditional risk factors of ischemic stroke.

Key Points

• This study evaluated the risk of ischemic stroke in patients with IIMs.

• Generally, IIMs are associated with an increased risk of ischemic stroke.

• Patients with DM had a 49% excess risk of ischemic stroke than controls.

• Subgroup analysis showed that Asian patients with IIMs were at increased risk of ischemic stroke, but not Americans.

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Funding

This work was supported by grants from Qingdao Municipal Hospital, (No. VIII ZYZJJ-YJ201814).

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Author notes

  1. Chao Zhen and Yabo Wang contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 5 Donghai Middle Road, Qingdao, Shandong Province, 266071, China

    Chao Zhen, Haifeng Wang & Xin Wang

  2. Department of Emergency, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China

    Yabo Wang

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  1. Chao Zhen
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Correspondence to Xin Wang.

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Zhen, C., Wang, Y., Wang, H. et al. The risk of ischemic stroke in patients with idiopathic inflammatory myopathies: a systematic review and meta-analysis. Clin Rheumatol 40, 4101–4108 (2021). https://doi.org/10.1007/s10067-021-05751-2

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  • DOI: https://doi.org/10.1007/s10067-021-05751-2

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