Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis
Jinoos Yazdany, Nick Pooley, Julia Langham, Lindsay Nicholson, Sue Langham, Nina Embleton, Xia Wang, Barnabas Desta, Volkan Barut, Edward R. Hammond
Abstract
Objective To evaluate the risk of stroke and myocardial infarction (MI) in adult patients with systemic lupus erythematosus (SLE) through a systematic review and meta-analysis. Methods We searched MEDLINE and EMBASE from inception to May 2020 to identify observational studies (cohort and cross-sectional) that evaluated risk of stroke and MI in adult patients with SLE compared with the general population or healthy controls. Studies were included if they reported effect-size estimates that could be used for calculating pooled-effect estimates. Random-effects models were used to calculate pooled risk ratios (RRs) and 95% CIs for stroke and MI. Heterogeneity quantified by the I 2 test and sensitivity analyses assessed bias. Results In total, 26 studies were included in this meta-analysis: 14, 5 and 7 studies on stroke, MI and both stroke and MI, respectively. The pooled RR for ischaemic stroke was 2.18 (95% CI 1.78 to 2.67; I 2 75%), intracerebral haemorrhage 1.84 (95% CI 1.16 to 2.90; I 2 67%), subarachnoid haemorrhage 1.95 (95% CI 0.69 to 5.52; I 2 94%), composite stroke 2.13 (95% CI 1.73 to 2.61; I 2 88%) and MI 2.99 (95% CI 2.34 to 3.82; I 2 85%). There was no evidence for publication bias, and sensitivity analyses confirmed the robustness of the results. Conclusions Overall, patients with SLE were identified to have a twofold to threefold higher risk of stroke and MI. Future research on the interaction between known SLE-specific modifiable risk factors and risk of stroke and MI to support development of prevention and treatment strategies are needed. PROSPERO registration number CRD42018098690.