Subclinical atherosclerosis in Behcet's disease and its inverse relation to azathioprine use: an updated meta-analysis

Merashli, Mira, Bucci, Tommaso ORCID: 0000-0003-2895-6234, Arcaro, Alessia, Gentile, Fabrizio and Ames, Paul RJ (2023) Subclinical atherosclerosis in Behcet's disease and its inverse relation to azathioprine use: an updated meta-analysis. CLINICAL AND EXPERIMENTAL MEDICINE, 23 (7). pp. 3431-3442.

Text MT and BD final.docx - Author Accepted Manuscript Available under License Creative Commons Attribution. Download (199kB)

Abstract

To evaluate the intima media thickness of carotid arteries (IMT) and its clinical, laboratory and treatment correlates in Behcet's disease (BD). Systematic search of EMBASE and PubMed databases from January 2016 to October 2022; we employed random effect meta-analyses for continuous outcomes and Peto's odds ratio for rare events. The meta-analysis included 36 case control studies: the IMT was greater in BD (n = 1103) than in controls (n = 832) (p < 0.0001) with wide heterogeneity (I² = 86.9%); a sensitivity analysis that included mean age of BD participants, gender, disease duration and activity, atherogenic index of plasma, blood pressure, C-reactive protein, ethnicity, smoking status, anti-inflammatory and immune suppressive agents, revealed that male gender, mean age of participants and azathioprine use (the latter two in inverse fashion) partly explained the heterogeneity variance (p = 0.02, p = 0.005, and p = 0.01). The IMT was greater in vascular (n = 114) than in non-vascular BD (n = 214) (p = 0.006). BD patients (n = 782) had a greater pooled prevalence of carotid plaques than controls (n = 537) (13.1% vs. 2.97%, p < 0.0001). Subclinical carotid artery atherosclerosis represents a vascular feature of BD, independently of the traditional cardiovascular risk factors. The inverse correlations between IMT, age and azathioprine use suggest that thicker carotid arteries at disease onset eventually regress with immune suppressive treatment: this assumption needs verification on adequately designed clinical trials.

Item Type:	Article
Uncontrolled Keywords:	Behcet's disease, Intima media thickness, Atherosclerosis, Azathioprine
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	01 Mar 2024 08:17
Last Modified:	01 Mar 2024 08:17
DOI:	10.1007/s10238-023-01084-3
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179011