| Background Atherosclerosis is a chronic and progressive arterial disease characterized by subintimal lipid deposition,proliferation of fibrous matrix components,which could gradually develop into atherosclerotic plaques.As a global public health problem,stroke is the second leading cause for death worldwide,which leads to a huge burden on families and society because of the high rate of residual disability.Carotid atherosclerosis(CAS)is a major cause of ischemic stroke,therefore,the prevention of the disease in a subclinical phase is important.,but the conclusion about risk factors for CAS is still controversial.The aim of our present meta-analysis and systematic review was to explore the modifiable risk factors for CAS,which is expected to throw light on the prevention of CAS.It provides a scientific basis for the development of primary and secondary prevention of stroke in clinical work.Methods and Analysis We searched PubMed from January 1962 to October 2018 to include longitudinal and cross-sectional studies.Search terms were “carotid”,“risk”,and “risk factor”.In order to avoid losing relevant studies,the reference lists of relevant reviews,meta-analyses and systematic reviews were hand-searched for further supplement.Through strict inclusion and exclusion criteria,eligible studies were screened,and data were extracted from each study.The quality of studies was assessed by using Agency for Healthcare Research and Quality(AHRQ)and the Newcastle-Ottawa Scale(NOS).Random effect model was used to pool the results of each study that could be included in the meta-analysis by R software,and corresponding forest plots were obtained.The heterogeneity was measured by I2 statistics.Subgroup analyses were used to reduce the heterogeneity.Moreover,sensitivity analyses were performed to examine whether the pooled effect was influenced by omitting any single study.Subsequently,funnel plots were used to assess the publication bias.Results A total of 14,700 articles were screened,of which 76 studies met the inclusion criteria.Finally,eleven factors had data eligible for the meta-analysis and all relevant studies were cross-sectional.A total of 48,847 subjects were included in the meta-analysis.92.6% studies were published from 2005 onwards and 72.8% samples were recruited from Asia and North America.Our meta-analysis of cross-sectional studies indicated nine factors(hyperlipidemia,hyperhomocysteinemia,hypertension,hyperuricemia,smoking,metabolic syndrome,hypertriglyceridemia,diabetes,and higher low density lipoprotein)were significantly associated with the presence of carotid plaque,among which four(hyperlipidemia,hyperhomocysteinemia,hypertension,and hyperuricemia)could elevate the risk of CAS by at least 50%;and one factor(hypertension)was associated with increased carotid intima-media thickness(CIMT).In the systematic review,another five factors(negative emotion,socioeconomic strain,alcohol,air pollution,and obstructive sleep apnea syndrome(OSAS)were also related to the presence of CAS.The crosssectional associations with most of the above 14 factors were further confirmed by longitudinal studies.Among them,the managements of 4 factors(hypertension,hyperlipidemia,diabetes and OSAS)were indicated to prevent carotid atherosclerosis by cohort studies.Conclusions The current meta-analysis and systematic review indicated that pre-existing disease,negative emotion,lifestyle,and diet could increase the risk of CAS,suggesting that these factors may serve as prevention targets.Further good-quality prospective studies are needed to confirm these findings. |
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