title: Atherosclerosis in systemic sclerosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Systemic sclerosis (SSc) is characterized by calcification, vasculopathy, and endothelial wall damage, all of which can increase the risk of developing atherosclerosis and cardiovascular disease. The aim of this study was to perform a systematic review and meta-analysis to determine whether the risk of atherosclerosis is increased in SSc patients compared to healthy individuals.
  
  
  METHODS
  A systematic search was performed to identify studies published in PubMed and the Cochrane database up to May 2010, and recently published abstracts were also reviewed. Two reviewers independently screened articles to identify studies comparing the rate of atherosclerosis in SSc patients to that in healthy controls. The studies utilized one of the following methods: angiography, Doppler ultrasound to assess plaque and carotid intima-media thickness (IMT), computed tomography, magnetic resonance imaging, flow-mediated vasodilation (assessed as the FMD%), the ankle-brachial index, or autopsy. For carotid IMT and FMD% values, we computed a pooled estimate of the summary mean difference and explored predictors of carotid IMT using random-effects meta-regression.
  
  
  RESULTS
  Of the 3,156 articles initially identified, 31 were selected for systematic review. The meta-analysis included 14 studies assessing carotid IMT and 7 assessing brachial artery FMD%. Compared to healthy controls, SSc patients had a higher prevalence of coronary atherosclerosis, peripheral vascular disease, and cerebrovascular calcification. Meta-analysis showed that SSc patients had increased carotid IMT (summary mean difference 0.11 mm, 95% confidence interval [95% CI] 0.05 mm, 0.17 mm; P = 0.0006) and lower FMD% (summary mean difference -3.07%, 95% CI -5.44%, -0.69%; P = 0.01) compared to controls. There was marked heterogeneity between the studies, which was mainly attributable to variations in disease duration and differences in the mean/median age between SSc patients and controls.
  
  
  CONCLUSIONS
  Patients with SSc have an increased risk of atherosclerosis compared to healthy subjects. Further studies should elucidate the mechanism of this increased risk.
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Au
authors.forename: Manjit K
authors.initials: MK
authors.lastname: Singh
authors.forename: Vijay
authors.initials: V
authors.lastname: Bodukam
authors.forename: Sangmee
authors.initials: S
authors.lastname: Bae
authors.forename: Paul
authors.initials: P
authors.lastname: Maranian
authors.forename: Rikke
authors.initials: R
authors.lastname: Ogawa
authors.forename: Brennan
authors.initials: B
authors.lastname: Spiegel
authors.forename: Maureen
authors.initials: M
authors.lastname: McMahon
authors.forename: Bevra
authors.initials: B
authors.lastname: Hahn
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D012306:Risk; D012595:Scleroderma, Systemic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography