Association between Chagas disease and the occurrence of stroke: systematic review with meta-analysis

This study aimed to conduct a systematic review of the association between Chagas disease and stroke, and to estimate the magnitude of this association through meta-analyses. A systematic review was conducted following the steps recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The MEDLINE via PubMed, Virtual Health Library, Web of Science, and Embase databases were searched, and all studies on the topic were considered, with no restrictions on language or publication period. Studies lacking the groups of interest (individuals with and without Chagas disease) or stroke as an outcome were excluded. Design-specific meta-analyses were performed using a random-effects model. Of the 1,695 studies identified, 7 were included in the systematic review and 6 in the meta-analysis. Among cohort studies (n = 2), the pooled meta-analysis estimate showed an increased risk of stroke among individuals with Chagas disease (RR = 1.92; 95%CI: 1.20-3.06). Among cross-sectional studies (n = 4), the pooled estimate revealed a higher prevalence of stroke among individuals with Chagas disease (PR = 1.63; 95%CI: 1.22-2.18). The certainty of evidence was rated as very low according to the GRADE approach. The results indicated an association between Chagas disease and stroke; however, they should be interpreted with caution, considering the heterogeneity across study designs and the small number of studies. Further studies with more homogeneous designs are needed to better understand this relationship.