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Decreased flow-mediated dilatation in patients with systemic lupus erythematosus: a meta-analysis
De-Guang Wang1, Xiao-Wu Tang, Ye Fan
1Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, People's Republic of China.
Insights
Systemic lupus erythematosus (SLE) patients exhibit significantly reduced flow-mediated dilatation (FMD%), indicating premature atherosclerosis. This meta-analysis confirms lower FMD% in SLE patients compared to controls, highlighting increased cardiovascular risk.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Biology
Background:
- Premature atherosclerosis is a major cause of mortality in Systemic Lupus Erythematosus (SLE).
- Early detection of atherosclerosis is crucial for managing SLE patients.
- Flow-mediated dilatation (FMD%) is a validated noninvasive marker for early atherosclerosis.
Purpose of the Study:
- To conduct a meta-analysis comparing FMD% in SLE patients versus healthy controls.
- To derive a precise estimate of the difference in FMD% between these groups.
- To investigate potential factors influencing FMD% variations in SLE.
Main Methods:
- Systematic search of databases for relevant cohort or case-control studies.
- Inclusion of studies using high-resolution ultrasonography to measure FMD%.
- Random effects meta-analysis to determine overall mean FMD% difference, with assessment for publication bias using funnel plots and Egger's test.
Main Results:
- Meta-analysis of 22 studies revealed significantly lower FMD% in SLE patients compared to healthy controls (SMD -1.19, P < 0.001).
- Substantial heterogeneity was observed (I² = 94.3%), primarily linked to SLE disease duration.
- Publication bias was detected but did not alter the significance of the main findings after trim-and-fill correction.
Conclusions:
- SLE patients demonstrate impaired vascular endothelial function, evidenced by reduced FMD%.
- FMD% serves as a reliable surrogate marker for subclinical atherosclerosis in SLE.
- Findings underscore the heightened cardiovascular risk in SLE patients and the utility of FMD% for early detection.
Abstract:
Premature atherosclerosis, the hallmark of cardiovascular diseases, has been found to be a significant cause of late deaths in systemic lupus erythematosus (SLE) patients. Therefore, early identification of atherosclerosis before the overt disease is curial for the management program of SLE. Flow-mediated dilatation (FMD%) is a reliable, noninvasive, easy to use, reproducible, and pathogenically relevant index for early atherosclerosis. In recent years, a number of studies have been performed to compare the mean FMD% difference between patients with SLE and healthy controls. However, these studies have shown inconclusive or even contradictory findings. In this study, to derive a more precise comparison of FMD% difference between SLE patients and healthy controls, a meta-analysis was performed. Databases were searched to identify all available studies comparing FMD% between SLE patients and healthy controls. The study eligibility criteria were cohort or case-control studies with data on both patients diagnosed with SLE and healthy controls, and use of high-resolution ultrasonography to detect FMD. Random effect meta-analysis was conducted to evaluate the overall mean FMD% difference between the two groups. Publication bias was detected by funnel plot and Egger's test. Meta-regression analysis was performed to investigate the potential influencing factors on FMD% difference. Of the 434 articles initially identified, 22 were finally included in the meta-analysis. Compared to healthy controls, SLE patients had significantly lower FMD% (standardized mean difference, -1.19; 95% CI, -1.63, -0.74; P < 0.001). There was significant heterogeneity among these studies (I (2) = 94.3%, P < 0.001), which was mainly due to variations in disease duration of SLE patients. The funnel plot showed a skewed shape, indicating a marked publication bias, which was further supported by the Egger's test (P = 0.006). However, after the correction for potential publication bias by using the trim-and-fill method, the main results for all studies combined were still significant (P < 0.001). Taken together, these findings support the current evidence on a higher cardiovascular burden in SLE and support using FMD% as a surrogate for premature atherosclerosis in SLE patients.
