Stratifying clinically relevant risk factors for acute ischemic stroke and cerebrovascular events in chagas disease: A systematic review and meta-Analysis

Background: Chagas Disease (CD) poses significant health risks, including an increased incidence of acute ischemic stroke (AIS). However, the specific risk factors for AIS in CD patients are not well-defined. This meta-analysis aims to identify clinically relevant risk factors for AIS in individuals with CD.

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).

Conclusion: 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.