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Coronary calcium in autoimmune diseases: A systematic literature review and meta-analysis
María Alejandra Martínez-Ceballos1, Jhoan Camilo Sinning Rey2, Juan Pablo Alzate-Granados3
1Research Division, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
Insights
Patients with autoimmune diseases (AID) have higher coronary artery calcium scores (CACS), indicating increased cardiovascular risk. This finding supports using CACS as a screening tool for atherosclerosis in AID patients.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Autoimmune diseases (AID) share pathophysiological mechanisms, including elevated cardiovascular disease (CVD) risk.
- Coronary artery calcium score (CACS) can enhance CVD risk assessment.
- Evaluating CACS in patients with six specific AIDs is crucial for understanding their CVD burden.
Purpose of the Study:
- To systematically review and meta-analyze the coronary artery calcium score (CACS) in patients with six autoimmune diseases (AID) compared to controls.
- To assess the utility of CACS in cardiovascular risk stratification for AID patients.
Main Methods:
- A systematic literature review and meta-analysis were conducted, searching databases up to January 2021.
- Included observational studies compared patients with rheumatoid arthritis, lupus erythematosus, Sjögren's syndrome, systemic sclerosis, dermatopolymyositis, and antiphospholipid syndrome to controls.
- The primary outcome was the coronary artery calcium score (CACS), analyzed using a random-effects model.
Main Results:
- Nineteen articles comprising 4568 subjects (2142 AID, 2426 controls) were meta-analyzed.
- Patients with AID exhibited a significantly higher pooled CACS (7.42) compared to controls.
- Meta-regression revealed age, HDL, and CRP levels influence CACS differences between groups.
Conclusions:
- Coronary artery calcium score (CACS) is elevated in patients with autoimmune diseases (AID), likely due to chronic inflammation.
- These findings suggest CACS can be a valuable screening tool for coronary atherosclerosis in AID patients.
- Integrating CACS into risk stratification models may improve cardiovascular event prediction in this population.
Background And Aims:
Autoimmune diseases (AID) share various clinical signs and symptoms and pathophysiological mechanisms including the increased risk of cardiovascular disease. The coronary artery calcium score (CACS) is potentially useful in improving the cardiovascular risk assessment. The aim of this study was to evaluate CACS in six AIDs analyzed as a group compared with controls through a systematic literature review (SLR) and meta-analysis.
Methods:
A literature search (Medline/OVID, Lilacs, Embase, and Cochrane/OVID) up to January 6, 2021 was made (PROSPERO CRD42020197182). Observational studies (patients with six AIDs: rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], Sjögren's syndrome, systemic sclerosis, dermatopolymyositis, and antiphospholipid syndrome) compared with controls were included. CACS, reported in Agatston units, was the primary outcome in both groups. Mean differences and a random-effects model (DerSimonian and Laird) were calculated.
Results:
Nineteen articles were meta-analyzed (4568 subjects: 2142 AID and 2426 controls). Mean age was 48.1 and 44.2 years, respectively and 75.6% and 84.9% were women, respectively. Of cases, 52.9% had RA, 44.4% SLE and 2.7% had systemic sclerosis. The pooled analysis showed a higher CACS in patients with AIDs (7.42; 95% CI 1.79 to 13.05; chi2-p = 0.01) compared with controls. Meta-regression models showed that age in cases and controls reduced the difference in CACS between groups (p < 0.05), HDL had an inverse relationship (p = 0.04), and CRP levels had a directly proportional relationship with CACS in cases (p = 0.036).
Conclusions:
The quantitative results of this meta-analysis suggest that CACS is higher in patients with AID, possibly due to chronic exposure to pro-inflammatory molecules. These results have clinical implications since the finding of highly elevated CACS in patients with AID will enable physicians and researchers to develop a risk stratification model that includes CACS as one of the screening tools for detecting coronary atherosclerosis in these patients.
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