Disease Activity in Inflammatory Bowel Disease Is Associated with Increased Risk of Myocardial Infarction, Stroke and Cardiovascular Death – A Danish Nationwide Cohort Study

Abstract

PurposeChronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is unclear. We therefore examined the risk of myocardial infarction (MI), stroke, and cardiovascular death in patients with IBD.MethodsIn a nationwide Danish population-based setting, a cohort of patients with incident IBD between 1996 and 2009 were identified in national registers. Hospitalizations with IBD as primary diagnosis, initiation of biological treatment and dispensed prescriptions of corticosteroids were all used as surrogate markers for disease activity, with flares classified as the first 120 days after diagnosis of IBD, and 120 days after a new corticosteroid prescription, biological treatment or IBD hospitalization, respectively. Continued corticosteroid prescriptions or IBD hospitalizations were defined as persistent activity, and periods free of such events were defined as remissions. Poisson regression was used to examine risk of MI, stroke, and cardiovascular death using a matched population-based comparison cohort as referenceResultsWe identified 20,795 IBD patients with a mean age of 40.3 years that were matched according to age and sex with 199,978 controls. During the study period, there were 365 patients with MI, 454 with stroke, and 778 with cardiovascular death. Patients with IBD had an overall increased risk of MI (rate ratio [RR] 1.17 [95% confidence interval 1.05–1.31]), stroke (RR 1.15 [1.04–1.27], and cardiovascular death (RR 1.35 [1.25–1.45]). During flares and persistent IBD activity the RRs of MI increased to 1.49 (1.16–1.93) and 2.05 (1.58–2.65), the RRs of stroke to 1.53 (1.22–1.92) and 1.55 (1.18–2.04) and for cardiovascular death 2.32 (2.01–2.68) and 2.50 (2.14–2.92). In remission periods, the risk of MI, stroke and cardiovascular death was similar to controls.ConclusionInflammatory bowel disease is associated with increased risk of MI, stroke, and cardiovascular death during periods with active disease.

Neurological Manifestations of Inflammatory Bowel Disease

“…Although the studied groups were not completely comparable in demographical and comorbidity features, the authors reported a higher prevalence of ischemic stroke in IBD patients (mainly in CD patients) than the general population (hazard ratios for UC and CD were 1.01 [95% conidence interval = 0.84-1.21] and 1.15 [95% conidence interval = 1.04-1.28], respectively) [24]. Similar results were reported in a Danish population-based seting (also with a mismatch in comorbidity distribution), showing a relative risk (RR) of 1.15 of sufering ischemic stroke in an IBD population (95% conidence interval 1.04-1.27) of sufering ischemic stroke in an IBD population [25]. Therefore, there is weak evidence of the higher incidence of ischemic stroke in IBD populations.…”

Association between aortic stiffness and left ventricular function in inflammatory bowel disease

“…Currently, the reported results for the risk of CV disease in the setting of IBD have been ambiguous, with some studies revealing an increased risk of both ischemic heart disease and cerebrovascular accidents and others showing no associations [25][26][27][28]. Additionally, a few studies have suggested that IBD patients have a lower burden for some traditional risk factors for CV disease, such as HT, DM, dyslipidemia and obesity, and that nontraditional risk factors may play an important role in IBD patients [28,29].…”

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

“…A retrospective study from North America [16] showed that the incidence of coronary artery disease in patients with IBD was higher as compared to a control group, in spite of a low incidence of traditional risk factors (smoking, diabetes, hypertension and hypercholesterolemia). Two Danish nation-wide cohort studies demonstrated an increased risk of ischemic heart disease and also showed that the risk was lower in those treated with 5-ASA [17,20]. Finally, a systematic review has confirmed the key role of chronic inflammation in causing progression of the atherosclerotic process and thus, coronary risk in IBD [19].…”