Markers of cardiovascular risk in patients with antiphospholipid syndrome: a meta-analysis of literature studies

Ann Med. 2014 Dec;46(8):693-702. doi: 10.3109/07853890.2014.959559. Epub 2014 Oct 13.


Several studies reported on the association between antiphospholipid syndrome (APS) and venous thrombosis. In contrast, little is known about cardiovascular (CV) risk in APS. We performed a meta-analysis on the impact of APS on major markers of CV risk. Studies on the relationship between APS and common carotid artery intima-media thickness (CCA-IMT), internal carotid artery IMT (ICA-IMT), carotid bifurcation IMT (BIF-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), and ankle-brachial index (ABI) were systematically searched in PubMed, Web of Science, Scopus, and EMBASE databases. Twenty case-control studies (668 cases, 678 controls) were included. Compared to controls, APS patients showed a higher CCA-IMT (mean difference [MD] 0.11 mm; 95% CI 0.07, 0.14), ICA-IMT (MD 0.08 mm; 95% CI 0.05, 0.11), BIF-IMT (MD 0.09 mm; 95% CI 0.06, 0.12) and a higher frequency of carotid plaques (OR 3.87; 95% CI 1.61, 9.31). Moreover, a lower FMD was found in APS subjects than in controls (MD -4.49%; 95% CI -6.20, -2.78), with no differences in NMD (MD -1.80%; 95% CI -4.01, 0.42). Finally, an increased prevalence of pathological ABI was found in APS patients compared to controls (OR 7.26; 95% CI 1.77, 29.71). Despite heterogeneity among studies, APS appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.

Keywords: Antiphospholipid syndrome; cardiovascular risk; endothelial dysfunction; intima-media thickness.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Ankle Brachial Index
  • Antiphospholipid Syndrome / epidemiology*
  • Antiphospholipid Syndrome / physiopathology*
  • Atherosclerosis / epidemiology*
  • Biomarkers
  • Cardiovascular Diseases / epidemiology*
  • Carotid Intima-Media Thickness
  • Humans
  • Risk Assessment
  • Vasodilation


  • Biomarkers

Supplementary concepts

  • Carotid Intimal Medial Thickness 1