@article {Yazdanye001247, author = {Jinoos Yazdany and Nick Pooley and Julia Langham and Lindsay Nicholson and Sue Langham and Nina Embleton and Xia Wang and Barnabas Desta and Volkan Barut and Edward Hammond}, title = {Systemic lupus erythematosus; stroke and myocardial infarction risk: a systematic review and meta-analysis}, volume = {6}, number = {2}, elocation-id = {e001247}, year = {2020}, doi = {10.1136/rmdopen-2020-001247}, publisher = {BMJ Specialist Journals}, abstract = {Objective To evaluate the risk of stroke and myocardial infarction (MI) in adult patients with systemic lupus erythematosus (SLE) through a systematic review and meta-analysis.Methods We searched MEDLINE and EMBASE from inception to May 2020 to identify observational studies (cohort and cross-sectional) that evaluated risk of stroke and MI in adult patients with SLE compared with the general population or healthy controls. Studies were included if they reported effect-size estimates that could be used for calculating pooled-effect estimates. Random-effects models were used to calculate pooled risk ratios (RRs) and 95\% CIs for stroke and MI. Heterogeneity quantified by the I2 test and sensitivity analyses assessed bias.Results In total, 26 studies were included in this meta-analysis: 14, 5 and 7 studies on stroke, MI and both stroke and MI, respectively. The pooled RR for ischaemic stroke was 2.18 (95\% CI 1.78 to 2.67; I2 75\%), intracerebral haemorrhage 1.84 (95\% CI 1.16 to 2.90; I2 67\%), subarachnoid haemorrhage 1.95 (95\% CI 0.69 to 5.52; I2 94\%), composite stroke 2.13 (95\% CI 1.73 to 2.61; I2 88\%) and MI 2.99 (95\% CI 2.34 to 3.82; I2 85\%). There was no evidence for publication bias, and sensitivity analyses confirmed the robustness of the results.Conclusions Overall, patients with SLE were identified to have a twofold to threefold higher risk of stroke and MI. Future research on the interaction between known SLE-specific modifiable risk factors and risk of stroke and MI to support development of prevention and treatment strategies are needed.PROSPERO registration number CRD42018098690.}, URL = {https://rmdopen.bmj.com/content/6/2/e001247}, eprint = {https://rmdopen.bmj.com/content/6/2/e001247.full.pdf}, journal = {RMD Open} }