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Subclinical atherosclerosis in Behcet's disease: A systematic review and meta-analysis
Mira Merashli1, Irina Chis Ster2, Paul Richard Julian Ames3
1Rheumatology Department, Bart's Health, London, UK.
Insights
Behcet disease (BD) is linked to impaired flow-mediated dilatation (FMD) and increased intima media thickness (IMT), indicating subclinical atherosclerosis. These findings persist even in inactive disease states, highlighting the need for atherosclerosis risk stratification in BD patients.
Area of Science:
- Vascular Medicine
- Rheumatology
- Cardiology
Background:
- Behcet disease (BD) is a multisystem inflammatory disorder.
- Subclinical atherosclerosis may contribute to cardiovascular complications in BD.
Purpose of the Study:
- To systematically review and meta-analyze studies evaluating subclinical atherosclerosis in BD.
- To assess endothelial function using flow-mediated dilatation (FMD) and endothelial-mediated dilatation (EMD).
- To measure carotid intima media thickness (IMT) as an indicator of atherosclerosis.
Main Methods:
- Systematic literature search of EMBASE and PubMed databases (January 2000 - January 2014).
- Inclusion of studies measuring FMD, EMD, or IMT in BD patients and controls.
- Meta-analysis performed according to PRISMA guidelines.
Main Results:
- BD patients exhibited significantly lower FMD compared to controls (SMD = -0.89).
- Increased IMT was observed in BD patients (SMD = 0.95), with significant statistical heterogeneity.
- EMD was lower in BD, but the result was not statistically significant (p = 0.06).
Conclusions:
- Flow-mediated dilatation is impaired in Behcet disease, irrespective of disease activity.
- Intima media thickness is increased in BD, reflecting underlying atherosclerosis.
- Further prospective studies are needed for atherosclerosis risk stratification in BD.
Objective:
To evaluate subclinical atherosclerosis in Behcet disease (BD), we performed a systematic review and meta-analysis of studies where atherosclerosis was determined by flow-mediated dilatation (FMD) and endothelial-mediated dilatation (EMD) and by measurement of intima media thickness (IMT) of carotid arteries.
Methods:
Systematic search of EMBASE and PubMed databases from January 2000 to January 2014 according to PRISMA guidelines.
Results:
Nine studies met the inclusion criteria on FMD/EMD, 11 on IMT and 4 on both. BD had lower FMD than controls (SMD = -0.89, 95% CI: -0.660 to -1.11, p < 0.001), which was confirmed by subgroup analyses on active and inactive patients (SMD = -1.17, 95% CI: -1.45 to -0.89 and SMD = -0.72, 95% CI: -0.97 to -0.46, p = 0.0001 for both). EMD was lower in BD but with a large estimate (SMD = 0.38, 95% CI: -0.79 to -0.03, p = 0.06, I(2) = 82.2%). IMT was greater in BD and the large estimate (SMD = 0.95, 95% CI: 0.63-1.28, p < 0.0001, I(2) = 87.6%) persisted after subgroup analysis on active and inactive patients (I(2) = 88.4% and 86.7%, respectively). Pooling IMT studies by a Newcastle Ottawa Scale of 5 and 6/7 yielded lower estimates (SMD = 0.54, 95% CI: 0.32-0.75, p < 0.0001, I(2) = 58.7% and SMD = 1.72, 95% CI: 1.35-2.09 p < 0.05, I(2) = 48.6%).
Conclusions:
FMD is impaired in BD even in inactive state and IMT is greater despite a degree of statistical heterogeneity that reflects the clinical heterogeneity of BD. Future prospective studies should account for risk stratification of atherosclerosis in BD.
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