Risk of Stroke in Patients with Chagas Disease: A Meta-Analysis of Observational Studies
Victória Morbach1, Laís Teixeira dos Reis2, Maria Eduarda Cavalcanti Souza3, Vitor Kendi Tsuchiya Sano4, Artur Menegaz de Almeida5, Samuel Luca Pinheiro6, Francisco Cezar Aquino de Moraes7, Francinny Alves Kelly8
1University of Cruzeiro Sul, 2CAM- University of Americas, 3University of Pernambuco, 4Federal University of Acre, 5Federal University of Mato Grosso, 6Federal University of Bahia, 7Federal University of Pará, 8Dante Pazzanese Institute of Cardiology
Objective:
This systematic review and meta-analysis aimed to evaluate whether Chagas disease infection increases the risk of stroke in patients.
Background:
Stroke is the second leading cause of death globally, accounting for 11% of all deaths and affecting over 13 million people annually. Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is a neglected tropical disease primarily affecting Latin America but increasingly recognized as a global health issue due to migration and globalization. Chronic Chagas cardiomyopathy, a common outcome of CD, has been suggested to increase the risk of thromboembolic events, including stroke. However, there is limited comprehensive evidence synthesizing the data on this association.
Design/Methods:
We systematically searched PubMed, Embase, Cochrane Central, and Scielo databases for studies analyzing stroke prevalence in CD patients compared to a control group without CD. Data were examined using the Mantel-Haenszel method, with 95% confidence intervals (CI). Binary endpoints were computed using odds ratio (OR), and statistical analysis was done using RStudio version 4.2.3, with p<0.05 considered statistically significant.
Results:
The initial search yielded 2,264 results. After removing duplicates and screening studies based on titles and abstracts, 15 studies met the predefined full-text review criteria. We included 9 studies, involving 4,562 patients (1,738 with CD). Most patients were men, with a mean age of 49-77 years. The pooled analysis indicated that CD patients had a higher risk of stroke compared to the control group (OR 2.08, 95% CI 1.17–3.69; p=0.01). Subgroup analysis of patients with Chagas cardiomyopathy showed a higher stroke risk (OR 1.74, 95% CI 1.02–3.00; p=0.04; I²=51%).
Conclusions:
CD is significantly associated with increased stroke risk, particularly in patients with cardiomyopathy. Prospective studies are needed to explore the prognostic significance of cerebrovascular events and the role of therapeutic anticoagulation in primary prevention.
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