An update on stroke and transient ischemic attack in Takayasu arteritis: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to update the global prevalence of stroke and transient ischemic attack (TIA) in Takayasu arteritis (TA) patients, assess subgroup variations, and identify modifiable risk factors.

Following PRISMA and MOOSE guidelines, eight databases (PubMed, EMBASE, Web of Science, Medline, and four Chinese databases) were systematically searched up to January 2025. A random-effects model was used to pool prevalence estimates, with subgroup analyses and risk factor evaluations. Heterogeneity was quantified using the I² statistic, and publication bias was assessed via funnel plots and Egger's test.

Thirty-four observational cohort studies (5112 patients involved) were included. The pooled prevalence of stroke/TIA in TA patients was 10.7% (95% CI: 8.4%-13.6%), with high heterogeneity (I²=90.4%). Subgroup analyses revealed higher prevalence of stroke/TIA in males than in females (20% vs. 11%), and in European populations (13%). Ischemic stroke predominated (7%, I²=80.7%), while hemorrhagic stroke was rare (2%, I²=0%). Smoking was the sole significant modifiable risk factor (RR=1.64, 95% CI: 1.13-2.38). Stroke accounted for 21.2% of all TA-related deaths.

TA patients face a high burden of stroke/TIA, with marked heterogeneity driven by population and methodological differences. Males and Europeans have higher prevalence of stroke/TIA. Smoking is the only modifiable risk factor in TA patients with stroke/TIA.