Risk
of Cerebrovascular Accident in Patients with
Polymyalgia Rheumatica: A Systematic Review and Meta-analysis

Background/Purpose: Several chronic inflammatory
disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have
been shown to increase risk of cerebrovascular accident (CVA). 
However, the data on polymyalgia rheumatica
(PMR), another common chronic inflammatory disease in older adults, are
limited.  Thus, to further investigate this association, we conducted a
systematic review and meta-analysis of observational studies
that compared the risk of CVA in patients with PMR versus participants
without it.

Methods: Two investigators independently searched
published studies indexed in MEDLINE, EMBASE and the Cochrane database from inception
to April 2015 using the terms “polymyalgia rheumatica” and “PMR” combined with
the terms for cerebrovascular disease.  A manual search of references of
selected articles was also performed.  The inclusion criteria were as
follows: (1) cohort or case-control study evaluating the
association between PMR and CVA (2) odds ratio (OR), relative risk (RR)
or hazard ratio (HR) or standardized incidence ratio (SIR) with 95% confidence
interval (CI) were provided.  Study
eligibility was independently determined by the two investigators.  The quality
of included studies was, again, independently assessed by the two investigators
using Newcastle-Ottawa scale.

RevMan 5.3 software was used for the data analysis.  Point
estimates and standard errors were extracted from individual studies and were
combined by the generic inverse variance method of DerSimonian and Laird.
 Given the high likelihood of between study variance, we used a
random-effect model rather than a fixed-effect model.  Statistical heterogeneity
was assessed using the Cochran’s Q test. 

Results: Out of 346 potentially relevant articles,
four studies (three retrospective cohort studies and one case-control study)
were identified and included in our data analysis.  The pooled risk ratio
of CVA in patients with PMR was 1.89 (95% CI, 1.50 to 2.37). The statistical
heterogeneity of this meta-analysis was high with an I² of
81%.

Conclusion: Our study demonstrated a significantly
elevated CVA risk among patients with PMR.