Association between inflammatory bowel disease and risk of stroke: a systematic review and meta-analysis of cohort studies

Abstract

Background/objectivesRecently, four meta-analyses have explored the association between inflammatory bowel disease (IBD) and the risk of stroke. These studies have demonstrated that people with IBD may be at an increased risk of stroke. However, some limitations such as high heterogeneity and the lack of uniformity in the types of research, especially the reuse of some sample sizes, cannot be neglected. These factors reduce the credibility of their research conclusions. Therefore, we conducted a meta-analysis to explore this possible association.MethodsPubMed, Embase, and Web of Science were searched from inception to 30 June 2023. A random effects model with the generic inverse variance method was used in this meta-analysis. The Review Manager software was used to obtain all relative risks (RRs) and their 95% confidence intervals (CIs). Publication bias was tested, and sensitivity and subgroup analyses were conducted to explore possible heterogeneities.ResultsThis meta-analysis included 12 cohort studies (involving 4,495,055 individuals). Meta-analysis of these data has shown that IBD was associated with an increased risk of stroke (RR = 1.19, 95%CI:1.14-1.24, p < 0.00001). Our results were stable and robust in subgroup and sensitivity analyses.ConclusionsOur results suggest that IBD is associated with an increased risk of stroke. To reduce the incidence of stroke, patients with IBD are encouraged to undergo stroke risk assessments, especially for young female patients; assessing the risk of ischemic stroke is of particular importance. Prospective studies considering stroke subtypes, IBD severity and treatments, regions, and other confounding factors are needed to further explore the nature of each association.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022373656.

C-reactive Protein: An Inflammatory Biomarker and a Predictor of Neurodegenerative Disease in Patients With Inflammatory Bowel Disease?

“…IBD represents a digestive tract pathology with an incidence that is increasing at a rapid rate. With its continual growth on a global scale, IBD has become an immense economic strain on health systems in recent years [ 9 ]. Beyond the new paradigm for managing these clinical cases, which includes "risk stratification" of patients, the application of highly effective therapy earlier in the disease course for high-risk patients, and the reassessment of response using objective outcome measures at specified points in time, a focus has been placed on studying the association of IBD with comorbidities such as cardiovascular and neurological diseases, to optimize the evolution of these patients where possible [ 5 ].…”

“…In IBD, CRP, adhesion molecules, and inflammatory cytokines are overexpressed both locally and systemically. These chronic inflammatory factors contribute to vascular endothelial dysfunction, impaired fibrinolysis, activation of the coagulation cascade, and abnormal platelet function resulting in increased arterial and venous thrombosis [ 9 ]. Consequently, IBD is associated with a higher risk of thromboembolic events and stroke due to thrombocytosis, coagulation abnormalities, hyperlipidemia, and hyperhomocysteinemia, thus contributing to the development of vascular dementia, which represents at least 20% of all dementia cases [ 12 ].…”

Monomeric C-Reactive Protein Potential Utilization in the Histological Assessment of Inflammatory Bowel Disease (IBD) Patients

“…The pathogenic mechanism in IBD has chronic inflammation as a main actor. The local and general overexpression of C-reactive protein (CRP), inflammatory cytokines, and adherent molecules contribute to vascular endothelial dysfunction, impaired fibrinolysis, activation of the coagulation cascade, and an abnormal platelet function, resulting in increased arterial and venous thrombosis with consequences at the level of intestinal mucosa [3,4]. The local inflammation alters the intestinal microbiota and the intestinal barrier, allowing toxic substances (and even inflammatory factors) produced by intestinal microorganisms to enter the circulatory system and induce extraintestinal complications [5].…”

Rates and Risk Factors of Acute Ischemic Stroke Mortality [A Multi-Center Prospective Cohort Study]

“…On the other side, the modifiable risk factors include elevated blood pressure [hypertension] or blood sugars [diabetes mellitus], dyslipidemia, obesity, physical inactivity and cardiovascular disorders . Other nontraditional risk factors are linked to ischemic stroke [e.g., inflammatory bowel disease [6] , blood pressure and nocturnal heart rate variability, endothelial function and recurrent cerebrovascular accidents [7] . However, there are heterogeneity in results and paucity of data.…”