Urolithiasis, Independent of Uric Acid, Increased Risk of Coronary Artery and Carotid Atherosclerosis: A Meta-Analysis of Observational Studies

Table 1

Studies on urolithiasis and arteriosclerosis risk included in the meta-analysis.

Basic characteristics of included studies
Study	Study design	Sex	Country	Sample size	Average age	Follow-up time	Outcome	Outcome measurement	Results
Kim et al. [22]	Cross-sectional study	Both (men and women)	Korean	62091	41.5	—	Coronary artery calcification (CAC)	CAC was assessed with a LightSpeed VCT XTe 64-slice multidetector CT scanner	The prevalence of detectable CAC was higher in participants with nephrolithiasis than those without nephrolithiasis (19.1% versus 12.8%).
Hsi et al. [23]	Cohort study	Both	United States	3276	69.5	2000–2012	Coronary artery calcification (CAC)	Multidetector row computerized tomography using a standardized protocol was performed on the participants	The study shows an independent association between a history of recurrent kidney stone formation and coronary artery calcium, specifically in participants with medium or high CAC scores.
Shavit et al. [27]	Case-control study	Both	United Kingdom	111	47	2011–2014	Abdominal aortic calcification	Obtained the CT images for aortic calcification using a standard radiology picture archiving and communication system workstation	The AAC severity score (presented as the median (25th percentile, 75th percentile)) was significantly higher in KSFs compared with the control group (0 (0, 43) versus 0 (0, 10), ).
Reiner et al. [20]	Cohort study	Both	United States	3549	White: 45.6; African American: 44.5	Included from 1985 to 1986. Follow-up for 20 years	Carotid atherosclerosis	Carotid IMT was determined by B-mode ultrasound (GE LOGIQ 700) examination using standard procedures after 20 years of follow-up	The association of kidney stones with carotid atherosclerosis was significant (OR 1.6, 95% CI 1.1–2.3, ), even after adjusting for major atherosclerotic risk factors.
Patil et al. [25]	Present study	Both	Saudi Aljouf	240	Stone group: 40.6; control group: 41.1	—	Carotid artery calcification	Any radiopaque nodular mass adjacent to the cervical vertebrae inside or below the C3-C4 intervertebral disc level, or the retromandibular area, generally at an angle of 45° from the angle of the mandible independent of the hyoid bone was considered a CAC	No significant relationship was found between the presence of CAC in the patients with renal stones and the control group. However, there was a trend for higher prevalence of CAC in renal stone patients.
Pirlamarla et al. [24]	Case-control study	Both	United States	925	—	2004–2013	Abdominal aortic calcification (AAC)	VC was measured as abdominal aortic calcification (AAC) between L1 and L4 vertebrae on noncontrast CT images	AAC was present in 46% of KSFs and 54% of controls (). Both AAC prevalence and AAC severity are greater in controls than KSFs.
Tanaka et al. [26]	Cohort study	Both	Japan	440	Stone group: 63; control group: 62	2010–2014	Aortic calcification	ACI was quantitatively measured using abdominal CT images above the common iliac artery bifurcation by scanning 10 times at 10-mm intervals	ACI was not significantly high in the stone group compared with the nonstone group.
Fabris et al. [21]	Cohort study	Both	Italian	84	—	—	Increased arterial stiffness	PWV measurements were obtained with PulsePen, a noninvasive portable device. The PWV was calculated as distance between the measurement sites divided by a transit time delay between radial and carotid pulse waves and expressed as meter per second (m/s)	The prevalence of AAS was higher among stone formers compared with nonstone formers (36 versus 12%, ), and the difference remained significant even after adjustment for potential confounders.

NA, not available; BMI, body mass index; ACI, aortic calcification index; CT, computed tomography; PWA, pulse-wave velocity; KSF, kidney stone former.