Cardiovascular Risk Profile Among Patients With Inflammatory Bowel Disease: A Population-based Study of More Than 100 000 Individuals

Aarestrup, Julie; Jess, Tine; Kobylecki, Camilla J; Nordestgaard, Børge G.; Allin, Kristine H.

doi:10.1093/ecco-jcc/jjy164

Cited by 69 publications

(63 citation statements)

References 17 publications

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“…Differences in risk across IBD phenotype, sex and age categories may be related to the different distributions of systemic inflammation and traditional cardiovascular risk factors across these groups. We have previously shown that patients with IBD, independent of disease activity, are more likely than the general population to have increased inflammation levels, while traditional cardiovascular risk factors are not altered 28. Patients with CD are at increased risk of acute arterial events compared with patients with UC, and patients with CD are more prone to a higher degree of systemic inflammation compared with patients with UC, among others evidenced by a higher level CRP production22 29 and serum concentration of interleukin-6 30.…”

Section: Discussionmentioning

confidence: 99%

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Kirchgesner

Andersen

Carrat

et al. 2019

Gut

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ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

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Section: Discussionmentioning

confidence: 99%

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Kirchgesner

Andersen

Carrat

et al. 2019

Gut

Self Cite

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“…There have been no prospective studies to assess disease activity by stool, blood or clinical markers and correlate it with ASCVD events over short-term or long-term. Most studies have used surrogate markers of inflammation like steroid use, hospitalization or escalation of therapy for disease activity[ 34 ]. Studies that measure disease activity and its duration in a prospective manner are needed to better assess the outcomes of ASCVD in patients with IBD.…”

Section: Non-traditional Risk Factors Of Ascvd In Patients With Ibdmentioning

confidence: 99%

Atherosclerotic cardiovascular disease in inflammatory bowel disease: The role of chronic inflammation

Weissman

Sinh

Mehta

et al. 2020

WJGP

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Inflammatory bowel disease (IBD) causes systemic vascular inflammation. The increased risk of venous as well as arterial thromboembolic phenomena in IBD is well established. More recently, a relationship between IBD and atherosclerotic cardiovascular disease (ASCVD) has been postulated. Systemic inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus, have well characterized cardiac pathologies and treatments that focus on prevention of disease associated ASCVD. The impact of chronic inflammation on ASCVD in IBD remains poorly characterized. This manuscript aims to review and summarize the current literature pertaining to IBD and ASCVD with respect to its pathophysiology and impact of medications in order to encourage further research that can improve understanding and help develop clinical recommendations for prevention and management of ASCVD in patients with IBD.

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“…It is noteworthy that systemic inflammation, in addition to causing functional myocardial abnormalities, can cause also structural heart abnormalities, e.g., accelerating coronary atherosclerosis [15,34,35,65]. Concurrency of action potential prolongation and preexisting structural myocardial abnormalities may explain the epidemiological observation that patients with active IBD have an increased risk of morbidity and mortality due to CVD [34,35].…”

Section: Discussionmentioning

confidence: 99%

Association between Corrected QT Interval and C-Reactive Protein in Patients with Inflammatory Bowel Diseases

et al. 2020

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Background and objectives: Electrocardiograph abnormalities (i.e., QT interval prolongation) have been described in inflammatory bowel diseases (IBD). We aimed to measure the QT interval in a cohort of patients with IBD and to analyze its relationship with clinical and inflammatory activity. Materials and Methods: We performed a cross-sectional study that included 38 IBD outpatients and 38 “age- and sex-matched” healthy controls. Nine patients had active IBD, and 29 were in clinical remission. Among the latter, 10 patients had sustained (lasting >1 year) and 19 had short-term remission (≤1 year). Corrected QT (QTc) interval was measured on standard 12-lead electrocardiograph. A systematic review of the literature on studies investigating the QT interval in patients with IBD was also performed. Results: QTc interval values were similar between IBD patients and healthy controls (417.58 ± 22.05 ms vs. 409.13 ± 19.61 ms, respectively; p: 0.479). Patients with active IBD had significantly higher QTc values (435.11 ± 27.31 ms) than both controls (409.13 ± 19.61 ms) and patients in remission (412.14 ± 17.33 ms) (p: 0.031). Post hoc analysis showed that the difference in QTc values between active IBD and remission was attributable to the group of patients with sustained remission (p < 0.05). Lastly, a significant correlation between QTc interval and C-reactive protein (CRP) values was observed (Spearman test: r = 0.563; p: 0.0005). Conclusions: Our study demonstrates an association between QTc duration and both clinical and inflammatory activity in patients with IBD. The higher the CRP value, the longer is the QTc duration. For practical purposes, all patients with active IBD should undergo a standard ECG. Prescription of drugs able to modify the QT interval should be avoided in patients with active IBD. The systematic review of the literature indicated that this is the first published study demonstrating an association between the QTc duration and CRP values in patients with IBD.

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Cardiovascular Risk Profile Among Patients With Inflammatory Bowel Disease: A Population-based Study of More Than 100 000 Individuals

Cited by 69 publications

References 17 publications

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Atherosclerotic cardiovascular disease in inflammatory bowel disease: The role of chronic inflammation

Association between Corrected QT Interval and C-Reactive Protein in Patients with Inflammatory Bowel Diseases

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