global cardiovascular risk in autoimmunity: a meta-analysis study from 16 countries on carotid intima-media thickness in rheumatoid arthritis and systemic lupus erythematosus

Autoimmune rheumatic diseases, such as rheumatoid arthritis (ra) and systemic lupus erythematosus (sle), are linked to increased cardiovascular risk. yet, the magnitude and mechanisms of subclinical atherosclerosis in these populations remain incompletely defined. carotid intima-media thickness (cimt) is a widely accepted and reliable surrogate marker used to detect early signs of atherosclerosis. a systematic review and meta-analysis of observational studies were conducted comparing cimt in adults with ra or sle to healthy controls. comprehensive searches of scopus, sciencedirect, web of science, and pubmed were conducted up to august 2024. study quality was evaluated using the newcastle-ottawa scale. a random-effects meta-analysis was conducted to calculate pooled mean differences (md) in cimt, with subgroup and sensitivity analyses to explore heterogeneity and robustness. a total of 32 studies were conducted in 16 countries, including asia, america, europe, australia, and africa. this study comprised 1,705 patients (835 ra, 870 sle) and 1,379 controls (642 ra-specific and 737 sle-specific). pooled analysis demonstrated significantly higher cimt in patients with autoimmune rheumatic diseases compared to controls (md 0.07 mm, 95% ci 0.06–0.08 mm) (p < 0.01). subgroup analysis revealed a greater cimt increase in ra (md 0.11 mm, 95% ci 0.10–0.12 mm) (p < 0.01) than in sle (md 0.04 mm, 95% ci 0.03–0.05 mm) (p < 0.01). sensitivity analyses confirmed the robustness of these findings. patients with ra and sle exhibit significantly increased cimt, with a more pronounced effect in ra, highlighting disease-specific atherosclerotic risk. these findings underscore the need for standardized cimt protocols and tailored cardiovascular prevention strategies in the autoimmune population.