Asthma and increased carotid intima-media thickness: A systematic review and meta-analysis

Asthma has been associated with early vascular changes that elevate the risk of atherosclerosis and cardiovascular diseases. Carotid intima-media thickness (CIMT) serves as a non-invasive marker for subclinical atherosclerosis and cardiovascular risk. However, existing literature presents conflicting results regarding CIMT measurements in asthmatic patients. This study aims to evaluate whether CIMT is elevated in asthma patients compared to healthy controls and to explore potential modifiers. We conducted a systematic review following PRISMA guidelines, performing a literature search across PubMed, Web of Science, ScienceDirect, and the WHO VHL. We calculated pooled standardized mean differences (SMD) with 95% confidence intervals (CI) to assess the differences in CIMT values. Heterogeneity was evaluated using the I² statistic, and subgroup analyses and meta-regression were utilized to identify sources of heterogeneity. Our review included a total of 10 studies. The analysis indicated significantly higher CIMT values in asthma patients compared to healthy controls, with a pooled SMD of 0.65 (95% CI: 0.19 to 1.12, p = 0.005). A limited number of studies addressed various factors, such as disease severity and the use of inhaled corticosteroids, which may influence CIMT measurements. Notably, asthmatic patients, particularly children and adolescents, exhibited higher CIMT values compared to healthy controls, suggesting a potential association with subclinical atherosclerosis in this demographic. However, these findings should be interpreted with caution due to the observational nature of the included studies and the risk of residual confounding. Further longitudinal research is necessary to elucidate the effects of disease characteristics and treatment on vascular health.