Stratifying Clinically Relevant Risk Factors for Acute Ischemic Stroke and Cerebrovascular Events in Chagas Disease: A Systematic Review and Meta-Analysis
Ana Santos1, Ocilio Ribeiro Gonçalves2, Saul Dominici3, Júlia dos Santos Monteiro4, Elizabet Taylor Pimenta Weba5, Anthony Hong1, Maria Tereza Camarotti6, Niels Pacheco-Barrios7, Marina Vilardo8, João Victor Araújo de Oliveira2, Arlindo Bispo da Silva Junior2, Marcio Yuri Ferreira9, Kelson James Almeida2
1University of Costa Rica, 2Federal University of Piauí, 3Federal University of Maranhão, 4University of Pernambuco, 5State University of Maranhão Tocantine Region, 6Pernambuco’s Health College, 7Universidad Científica del Sur, 8Catholic University of Brasilia, 9Lenox Hill Hospital/Northwell Health
Objective:
This study aims to systematically review and analyze the literature to identify risk factors for acute ischemic stroke (AIS) and cerebrovascular events in patients already diagnosed with Chagas Disease (CD).
Background:
CD poses significant health risks, including an increased incidence of AIS. However, the specific risk factors for AIS in CD patients are not welldefined.
Design/Methods:
We performed a systematic review and meta-analysis by searching PubMed, Embase, Web of Science, and the Cochrane Library up to August 2024. Primary outcomes evaluated in AIS patients with CD included reduced left ventricular ejection fraction (LVEF), anticoagulation therapy, atrial fibrillation (AF), left ventricular apical aneurysm (LVAA), pacemaker use, and coronary artery disease (CAD). Risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results:
Six studies were included, involving 1,229 patients (48% male). The analysis revealed a higher risk of AIS in CD patients with reduced LVEF (RR 3.38; 95% CI 1.38 - 8.27), AF (OR 4.85; 95% CI 2.13 - 11.02), LVAA (OR 3.76; 95% CI 1.96 - 7.21), and pacemaker use (OR 2.37; 95% CI 1.38 - 4.09). Anticoagulation therapy was associated with a reduced likelihood of stroke (OR 0.28; 95% CI 0.19 - 0.41). No significant association was found between CAD and stroke risk (OR 1.56; 95% CI 0.93 - 2.59).
Conclusions:
Reduced LVEF, AF, LVAA, and pacemaker use are correlated with higher stroke incidence in CD patients, while anticoagulation therapy diminishes this risk. Further randomized studies are needed to refine AIS prevention strategies for this population.
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