Evaluating subclinical atherosclerosis, arterial stiffness, and lipid profile in patients with anti neutrophilic cytoplasmic antibodies associated vasculitis: a systematic review and meta-analysis.

BACKGROUND

Cardiovascular diseases (CVD) account for a significant portion of deaths in anti-neutrophilic cytoplasmic antibodies associated vasculitis (AAV). Previous studies have shown the presence of accelerated subclinical atherosclerosis and arterial stiffness in AAV patients that is not solely explained by conventional cardiovascular risk factors. Moreover, lipid profile may be deranged in such patients. The evidence of subclinical atherosclerosis, arterial stiffness, and lipid profile have not been analyzed in AAV patients.

METHODS

PubMed, Google Scholar and Embase databases were searched from inception till January 2024 for studies that measured parameters of arterial structure and function ((carotid intimal media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV)) and lipid profile of adult patients with AAV and matched healthy controls. Outcomes included standardized mean difference (SMD) with 95% confidence interval (CI) of CIMT, FMD, PWV and lipid profile between AAV patients and healthy controls. The analysis was done via Revman 5.1.

RESULTS

Ten studies comprising 360 AAV patients and 487 healthy controls were included in this analysis. CIMT value was significantly higher in AAV patients as compared to healthy controls [SMD = 0.34, CI = 0.09-0.59, = 0.008, I = 56%]. Moreover, PWV was significantly higher in AAV patients [SMD = 0.53, CI = 0.26-0.79, < 0.001, I = 0%] as compared to healthy controls. The lipid profile was not significantly different among the AAV patients and the healthy controls except the total triglycerides level.

CONCLUSION

This review validates the occurrence of subclinical atherosclerosis and arterial stiffness in AAV patients. Regular assessment using surrogate markers is warranted with aim to reduce CVD in such patients.