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Helen Chung, Sourabh Arora, Karim Damji, Ezekiel Weis; The association of pseudoexfoliation syndrome (PEX) with cardiovascular (CVD) and cerebrovascular (CVA) disease: a systematic review and meta-analysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2653. doi: https://doi.org/.
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Pseudoexfoliation syndrome (PEX) is a systemic disorder and evidence of its association with CVD and CVA is controversial. The aim of this meta-analysis was to quantitatively summarize the current body of literature on this association.
A comprehensive literature search within PubMed and Embase was performed, as was a hand search of references. Studies were included if they were published in English and reported incidence of CVD and/or CVA among PEX and control groups.
CVD included the diagnostic terms coronary artery disease, ischemic heart disease, and angina. CVA included acute cerebrovascular disease, stroke, and white matter hyperintensities on MRI. After screening 1853 studies, 28 articles were reviewed, and 13 eligible studies were selected that reported patients from the following populations: Turkish, Lithuanian, Australian, Norwegian, Finnish, Croatian, Spanish, Indian, Greek, and American. Twelve studies enrolling 8310 individuals with PEX evaluated CVD. Using a random effects model, the summary odds ratio (OR) was 1.46 [1.13-1.89 95% confidence interval], p<0.01). For CVA using 5 studies, there were 1036 PEX patients yielding a summary OR of 2.16 [1.16-4.03], p=0.02. For combined vascular events (CVE) using all 13 studies, there were 8346 PEX patients and 135,570 control patients yielding a summary OR of 1.58 [1.31-1.91], p<0.0001 Meta-regression in the CVD and CVE groups respectively was not significant for age (p=0.29, 0.13), sex (p=0.82, 0.56), and study design (p=0.20, 0.16). A similar analysis was not performed on CVA studies, as this data was not identifiable in published studies. Analysis for publication bias with Egger’s test was not significant for studies reporting CVD, CVA, and CVE, respectively (p=0.78, 0.07, 0.13).
There is strong evidence that PEX is significantly associated with both cardiovascular and cerebrovascular disease in the populations studied.
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