Subclinical atherosclerosis in Behcet’s disease: A systematic review and meta-analysis

To evaluate subclinical atherosclerosis in Behcet disease (BD), we performed a systematic review and meta-analysis of studies where atherosclerosis was determined by flow-mediated dilatation (FMD) and endothelial-mediated dilatation (EMD) and by measurement of intima media thickness (IMT) of carotid arteries. Systematic search of EMBASE and PubMed databases from January 2000 to January 2014 according to PRISMA guidelines. Nine studies met the inclusion criteria on FMD/EMD, 11 on IMT and 4 on both. BD had lower FMD than controls (SMD = −0.89, 95% CI: −0.660 to −1.11, p < 0.001), which was confirmed by subgroup analyses on active and inactive patients (SMD = −1.17, 95% CI: −1.45 to −0.89 and SMD = −0.72, 95% CI: −0.97 to −0.46, p = 0.0001 for both). EMD was lower in BD but with a large estimate (SMD = 0.38, 95% CI: −0.79 to −0.03, p = 0.06, I2 = 82.2%). IMT was greater in BD and the large estimate (SMD = 0.95, 95% CI: 0.63–1.28, p < 0.0001, I2 = 87.6%) persisted after subgroup analysis on active and inactive patients (I2 = 88.4% and 86.7%, respectively). Pooling IMT studies by a Newcastle Ottawa Scale of 5 and 6/7 yielded lower estimates (SMD = 0.54, 95% CI: 0.32–0.75, p < 0.0001, I2 = 58.7% and SMD = 1.72, 95% CI: 1.35–2.09 p < 0.05, I2 = 48.6%). FMD is impaired in BD even in inactive state and IMT is greater despite a degree of statistical heterogeneity that reflects the clinical heterogeneity of BD. Future prospective studies should account for risk stratification of atherosclerosis in BD.