title: Chagas cardiomyopathy is associated with higher incidence of stroke: a meta-analysis of observational studies.
abstract: BACKGROUND
  Chagas disease (CD) has been associated with an elevated risk of stroke, but current data are conflicting and prospective controlled studies are lacking. We performed a systematic review and meta-analysis examining the association between stroke and CD.
  
  
  METHODS
  Pubmed, Embase, Cochrane Central, Latin American database, and unpublished data were searched with the use of the following terms: ("Chagas" OR "American trypanosomiasis") AND ("dilated" OR "ischemic" OR "idiopathic" OR "nonChagasic" OR "stroke" OR "cerebrovascular"). We included studies that reported prevalence or incidence of stroke in a CD group compared with a non-CD control group. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model.
  
  
  RESULTS
  A total of 8 studies and 4,158 patients were included, of whom 1,528 (36.7%) had CD. Risk of stroke was elevated in the group of patients with CD (OR 2.10, 95% CI 1.17-3.78). Similar results were observed in a subanalysis of cardiomyopathy patients (OR 1.74, 95% CI 1.02-3.00) and in sensitivity analysis with removal of each individual study. Furthermore, exclusion of studies at higher risk for bias also yielded consistent results (OR 1.70, 95% CI 1.06-2.71). Subanalysis restricted to studies that included patients with the indeterminate form found no significant difference in the stroke prevalence between CD and non-CD patients (OR 3.10, 95% CI 0.89-10.77).
  
  
  CONCLUSIONS
  CD is significantly associated with cerebrovascular events, particularly among patients with cardiomyopathy. These findings underline the need for prospective controlled studies in patients with Chagas cardiomyopathy to ascertain the prognostic significance of cerebrovascular events and to evaluate the role of therapeutic anticoagulation in primary prevention.
authors.affiliation: Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Rhanderson N
authors.initials: RN
authors.lastname: Cardoso
authors.affiliation: Department of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas. Electronic address: yuribulcao@gmail.com.
authors.forename: Francisco Yuri B
authors.initials: FY
authors.lastname: Macedo
authors.affiliation: Department of Tropical Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Melissa Nolan
authors.initials: MN
authors.lastname: Garcia
authors.affiliation: Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Garcia
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Benjo
authors.affiliation: Department of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.affiliation: Department of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.affiliation: Department of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002598:Chagas Cardiomyopathy / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D016019:Survival Analysis
keywords: Chagas cardiomyopathy; meta-analysis; stroke