Early Atherosclerosis in Pediatric Systemic Lupus Erythematosus: A Systematic Review and Meta‐Analysis

ABSTRACT Objective Adults with systemic lupus erythematosus (SLE) are at a higher risk of cardiovascular complications. Numerous meta‐analyses in adults with SLE have consistently demonstrated altered surrogate parameters of atherosclerosis (subclinical atherosclerosis). However, meta‐analyses assessing the impact of pediatric SLE (pSLE) on cardiovascular health are lacking. Herein, we perform a systematic review and meta‐analysis of studies assessing subclinical atherosclerosis in pSLE. Methods Embase, Web of Science, and PubMed databases were systematically searched for pertinent literature published between January 1965 and February 2024. Patients with SLE and healthy participants were included as cases and controls, respectively. Online PICO portal, Newcastle–Ottawa scale, Review Manager and R software, and GRADEpro GDT tool were used for study deduplication and data extraction, study quality evaluation, data synthesis/analysis (including meta‐regression), and certainty of evidence assessment, respectively. Results A total of 9 studies (out of 126 citations), including 1021 participants (528 cases and 493 controls), were included in the analysis. Carotid intima–media thickness (CIMT) and pulse wave velocity (PWV) were significantly higher in cases as compared to controls [mean difference (MD) 0.04 (95% CI 0.01–0.08) mm, p = 0.007 and MD 0.48 (95% CI 0.02–0.94) m/s, p = 0.04, respectively]. The flow‐mediated dilatation was similar in the two groups. Significant heterogeneity was observed for all the outcome measures. On meta‐regression analysis, disease duration correlated significantly with both CIMT MD and PWV MD. Conclusions A “low”‐quality evidence suggests that pSLE may adversely impact vascular microanatomy and physiology. Longitudinal studies are needed to precisely quantify the cardiovascular risk in pSLE. Registration PROSPERO (CRD42022323752).