title: Subclinical atherosclerosis in patients with systemic lupus erythematosus: A systemic review and meta-analysis.
abstract: OBJECTIVE
  Systemic lupus erythematosus (SLE) is associated with increased risk of cardiovascular disease. Carotid intima media thickness (CIMT) and carotid plaques are both frequently used to identify populations at higher cardiovascular risk. A systematic literature search and meta-analysis were performed to evaluate CIMT and carotid plaques difference between SLE patients and normal controls.
  
  
  METHODS
  The literatures comparing markers of cardiovascular risk (CIMT and prevalence of carotid plaques) in SLE and controls were systematically searched in PubMed, EMBASE and Cochrane databases. The overall mean CIMT difference and pooled odds ratio (OR) for the prevalence of carotid plaques between SLE patients and control groups were calculated by fixed-effects or random-effect model analysis. Meta-regression was performed to explore the potential influencing factors. Publication bias was examined by a funnel plot and Egger's test.
  
  
  RESULTS
  A total of 80 studies (6085 SLE patients and 4794 controls) were included in the final analysis, 71 studies with data on CIMT (4814 cases and 3773 controls) and 44 studies reporting on the prevalence of carotid plaques (4417 cases and 3528 controls). As compared to controls, SLE patients showed a higher CIMT (WMD: 0.07 mm; 95%CI: 0.06, 0.09; P<0.001), and an increased prevalence of carotid plaques (OR: 2.45; 95%CI: 2.02, 2.97; P<0.001). Meta-regression models showed that traditional cardiovascular risk factors (age, HDL and triglyceride of SLE patients) and lupus related risk factors (as expressed by duration, ESR, SLEDAI and steroids) had a significant influence on CIMT, steroids and triglyceride had significant influence on the prevalence of carotid plaques.
  
  
  CONCLUSIONS
  Our findings support the current evidence base for an increased cardiovascular burden in SLE patients and support the use of CIMT and carotid plaques in observational studies in SLE patients. The findings are of importance to design more specific prevention and treatment strategies.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China; Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China.
authors.forename: Guo-Cui
authors.initials: GC
authors.lastname: Wu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China; Graduate School, Wannan Medical College, West of Wenchang Road, University Park, Wuhu, Anhui 241002, China.
authors.forename: Hai-Rong
authors.initials: HR
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China; Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China.
authors.forename: Rui-Xue
authors.initials: RX
authors.lastname: Leng
authors.affiliation: Department of Rheumatology, Anhui Provincial Hospital, Hefei, China.
authors.forename: Xiang-Pei
authors.initials: XP
authors.lastname: Li
authors.affiliation: Department of Rheumatology, Anhui Provincial Hospital, Hefei, China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China; Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China. Electronic address: panhaifeng1982@sina.com.
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Pan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China; Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui, China. Electronic address: ydqahmu@gmail.com.
authors.forename: Dong-Qing
authors.initials: DQ
authors.lastname: Ye
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology*; D015415:Biomarkers / Q000032:analysis; D059168:Carotid Intima-Media Thickness; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: Atherosclerosis; Carotid intima media thickness; Carotid plaques; Systemic lupus erythematosus