Risk of stroke high in patients with arthritis,specially in young ; Plos One

In a recent development , researchers have highlighted that stroke risk was increased in multiple arthritis and similar between ischemic and hemorrhagic stroke; further suggesting that young patients with arthritis had the highest risk. The findings have been put forth in Plos One.

According to the Global Burden of Disease Study 2016, stroke accounts for almost 5% of all disability-adjusted life-years and 10% of all deaths worldwide, engendering substantial physical and emotional consequences for patients and their families . Thus, there is an urgent need to clearly understand stroke risk. A number of modifiable risk factors have been associated with most of the population attributable risk in stroke worldwide; these include hypertension, diabetes mellitus, obesity, hyperlipidemia, smoking, alcoholism, physical inactivity, diet, psychosocial factors, and cardiac causes. However, studies on these traditional risk factors (RF) cannot fully explain the continuous increase in stroke risk.

Inflammatory mediators such as cytokines may be the critical factor linking arthritis and stroke. Arthritis involves the increased generation of inflammatory cytokines produced in the joints. These eventually spill into the circulation, where they can cause increased production of adhesion molecules and other proinflammatory molecules. This leads to monocyte and leukocyte adhesion to the endothelial cells of the vessel wall, followed by chemotaxis of these into vessel walls, which leads to atherosclerosis, and ultimately to vascular events such as stroke .This led the research team to have a deeper look into the matter.

For the study design ,the team searched Chinese and English databases to identify relevant studies from inception to April 30, 2020. Only studies adjusting at least for age and sex were included. We calculated pooled effect estimates for relative risk (RR) and 95% confidence interval (CI) and identified potential sources of heterogeneity and publication bias.

Data analysis put forth some interesting facts.

• A total of 1,348 articles were retrieved, and after an preliminary screening of titles and abstracts, 69 were reviewed for full text, and finally, 32 met the criteria for meta-analysis.
• Stroke risk in arthritis was significantly increased in studies adjusting for age and sex (RR = 1.36, 95% CI: 1.27–1.46) and for at least one traditional risk factor (RR = 1.40, 95% CI: 1.28–1.54).
• The results of studies stratified by stroke subtype were consistent with the main finding (ischemic stroke: RR = 1.53, 95% CI: 1.32–1.78; hemorrhagic stroke: RR = 1.45, 95% CI: 1.15–1.84).
• In subgroup analysis by arthritis type, stroke risk was significantly increased in rheumatoid arthritis (RR = 1.38, 95% CI: 1.29–1.48), ankylosing spondylitis (RR = 1.49, 95% CI: 1.25–1.77), psoriatic arthritis (RR = 1.33, 95% CI: 1.22–1.45), and gout (RR = 1.40, 95% CI: 1.13–1.73) but not osteoarthritis (RR = 1.03, 95% CI: 0.91–1.16).
• Age and sex subgroup analyses indicated that stroke risk was similar by sex (women: RR = 1.47, 95% CI: 1.31–1.66; men: RR = 1.44, 95% CI: 1.28–1.61); risk was higher with younger age (<45 years) (RR = 1.46, 95% CI: 1.17–1.82) than older age (≥65 years) (RR = 1.17, 95% CI: 1.08–1.26).

For the full article follow the link: https://doi.org/10.1371/journal.pone.0248564

Primary source:PLOS ONE