Background Behçet's disease is a systemic vasculitis characterised by an elevated risk of venous and arterial thrombosis: several studies addressed the issue of premature atherosclerosis assessed by functional tests (flow and endothelial mediated vasodilatation: FMD/EMD) and measurement of intima media thickness (IMT) of carotid arteries with varied results.
Objectives To perform a systematic review and meta-analysis on the association between Behçet' disease (BD) and atherosclerosis detected as endothelial dysfunction (FMD & EMD) and IMT of carotid arteries.
Methods The EmBase and PubMed databases were systematically searched from January 2000 to January 2014 according to the PRISMA guidelines. Two authors independently extracted data by using predefined eligibility criteria.
Results We found 24 studies that met criteria for inclusion in our analysis, 9 on FMD/EMD, 11 on IMT and 4 on both. The FMD analysis involved 554 BD patients and 472 matched controls: FMD was impaired in BD but with a high estimate (SMD 1.841, 95% CI, 1.125-2.558, p<0.001, I2=95.6%); subgroup analysis on inactive patients confirmed impaired FMD with a valid estimate (SMD 0.740, 95% CI, 0.510-0.970, I2 =35.5%). The EMD analysis involved 360 BD patients and 306 matched controls: EMD was impaired but with a large estimate (SMD 0.380, 95% CI, -0.027-0.788, p=0.06, I2=82.2%); subgroup analysis was unrevealing. The IMT analysis involved 848 patients with BD and 677 controls: BD patients showed greater IMT than controls but with a large estimate (SMD -1.158, 95%CI, -0.522 to -0.793, p<0.0001, I2=88.4%); subgroup analysis on active then on inactive patients still revealed a large estimate (I2=88.4% and 86.7% respectively), even when BD with no vascular involvement and no cardiovascular risk factor were excluded from the analysis (I2=85.9%). By re-approached the IMT analysis according to the Newcastle Ottawa Quality Assessment Score (NOQAS), studies with a NOQAS of 5 were consistent with greater IMT in BD with valid estimate (SMD -1.720, 95% CI, -2.093 to -1.346, p<0.0001, I2=48.6%); similar data were seen for BD patients with a NOQAS 6/7 (SMD -0.537, 95% CI, -0.753 to-0.320 p<0.05, I2=58.7%).
Conclusions Atherosclerosis detected by FMD and IMT is present in BD: the moderate degree of statistical heterogeneity reflects in the clinical heterogeneity of BD that should be taken into account in future prospective studies.
Subclinical Atherosclerosis in Behçet's disease: An overlooked association. Saarbrücken Germany, LAP LAMBERT Academic Publishing, 2013.
Disclosure of Interest None declared