Abstract Background Cardiac manifestations in systemic immune-mediated diseases (SIDs) have been associated with an increased risk of adverse clinical outcome. However, cardiac involvement might reflect a more severe burden of systemic inflammation rather than a direct causal link to inferior survival. Since an increased likelihood of cardiovascular death among patients with SIDs remains uncertain, the present meta-analysis sought to derive pooled estimates of the association between SIDs and cardiovascular death. Methods Data search was conducted from inception through September, 28, 2024 using PubMed, Cochrane Library, ClinicalTrials.gov to search patients with SIDs and longitudinal assessment of cardiovascular death. From 76,531 retrieved, we selected 39 studies comprising 171,748 patients affected by Rheumatoid Arthritis, Systemic Lupus Erythematous, Granulomatosis with Polyangitiis, Sjogren Syndrome, Ankylosing Spondylitis, Chron Disease, Ulcerative Colitis Hazard ratios and CIs for cardiovascular death were recorded for SIDs in general and for SIDs subtypes. Pre-specified sensitivity analyses and meta-regression analysis for age, sex and follow-up duration were performed. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Results SIDs were associated with an increased risk of cardiovascular death (HR 1.26; 95% CI 1.09-1.47; p=0.002). The association between SIDs and the increased risk of cardiovascular death retained significance across sensitivity analyses. By meta-regression analysis, female sex affected the association with cardiovascular death (95% CIs 0.016-1.652; p= 0.046), whereas follow-up duration and age did not. Among specific SIDs types, only Lupus, Granulomatosis with polyangiitis, and Rheumatoid arthritis retained a significant association with increased cardiovascular mortality (Figure 1). Conclusions SIDs, particularly Lupus, Granulomatosis with polyangiitis, and Rheumatoid arthritis, were associated with an increased risk of cardiovascular death.Figure 1
Cambini et al. (Sat,) studied this question.