Patients with inflammatory bowel disease are at increased risk of atherothrombotic disease: A systematic review with meta-analysis

D’Ascenzo, Fabrizio; Bruno, Francesco; Iannaccone, Mario; Testa, Giulia; Filippo, Ovidio De; Giannino, Giuseppe; Caviglia, Gian Paolo; Bernstein, Çharles N.; Ferrari, Gaetano Maria De; Bugianesi, Elisabetta; Armandi, Angelo; Ribaldone, Davide Giuseppe

doi:10.1016/j.ijcard.2023.02.042

Cited by 12 publications

(13 citation statements)

References 35 publications

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“…The HR for ACS in our study, 1.30 (95% CI: 1.24–1.30) was nearly identical to that found in the hitherto most comprehensive and recent meta‐analysis 1.29 (95% CI: 1.14–1.46) 22 . Our results were also consistent with previous large population‐based cohort studies.…”

Section: Discussionsupporting

confidence: 92%

“…15,17,25 The HR for ACS in our study, 1.30 (95% CI: 1.24-1.30) was nearly identical to that found in the hitherto most comprehensive and recent meta-analysis 1.29 (95% CI: 1.14-1.46). 22 Our results were also consistent with previous large population-based cohort studies. IBD patients, 15,17 given the study design of these studies and that these countries have universal access to publicly funded healthcare including inpatient care.…”

Section: Ta B L E 1 (Continued)supporting

confidence: 93%

“… 14,18 Furthermore, four meta‐analyses mainly including patients diagnosed during the pre‐biologic era also support an increased risk in patients with IBD (summarised in Table S1b). 19–22 …”

Section: Introductionmentioning

confidence: 99%

“…14,18 Furthermore, four meta-analyses mainly including patients diagnosed during the pre-biologic era also support an increased risk in patients with IBD (summarised in Table S1b). [19][20][21][22] However, methodological limitations may hamper the interpretation of these studies, for instance, low sample size, 18 or unvalidated and varied definitions of IBD and/or ACS. 14,16,[23][24][25][26] In addition, during the last decade, more intense treatment strategies and new therapeutic options have been introduced in the management of IBD, and the average level of disease control has improved.…”

Section: Introductionmentioning

confidence: 99%

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Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study

Eriksson,

Sun,

Bryder

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundThere are conflicting data on the risk of acute coronary syndrome (ACS) in patients with inflammatory bowel disease (IBD). Only a few previous reports include patients diagnosed during the last decade.AimTo assess and compare the risk of ACS between patients with IBD and the general population.MethodsIn this cohort study, we used nationwide registers to identify patients diagnosed with IBD in Sweden 2003–2021. Every patient was matched by birth year, sex, calendar year and area of residence with up to 10 general population comparators. The primary outcome was incident ACS. We used semi‐parametric Cox proportional hazard models to estimate hazard ratios (HRs).ResultsWe identified 76,517 patients with IBD (Crohn's disease [CD], N = 22,732; ulcerative colitis [UC], N = 42,194 and IBD—unclassified, N = 11,591) and 757,141 comparators. During a median follow‐up of 8 years, 2546 patients with IBD (37.5/10,000 person‐years) were diagnosed with ACS compared with 19,598 (28.0/10,000 person‐years) among comparators (HR 1.30; 95% confidence interval 1.24–1.35) after adjustments for confounding factors, and approximately one extra case of ACS in 100 IBD patients followed for 10 years. The highest HRs for ACS were in patients with elderly onset IBD (≥60 years) and among patients with CD or UC with extra‐intestinal manifestations. No increased HRs were observed in patients diagnosed with IBD before the age of 40.ConclusionIn this contemporary cohort of patients with IBD, exposed to modern IBD care, there was an increased risk for ACS compared with individuals from the general population.

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Section: Discussionsupporting

confidence: 92%

Section: Ta B L E 1 (Continued)supporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study

Eriksson,

Sun,

Bryder

et al. 2024

Aliment Pharmacol Ther

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“…11 Consistent with this finding, excess CV risks were also found in SpA-, Pso-and IBD-related metaanalyses: the risks of major CV events like stroke and MI varied between 1.2 and 1.5 in comparison with non-IMID individuals. [12][13][14] The high prevalence of major CV risk factors (e.g. smoking, hypertension or diabetes) can only partially explain the enhanced CV morbidity and mortality in IMID patients, with Pso and RA confirmed as independent CV risk factors.…”

Section: Introductionmentioning

confidence: 99%

Reducing cardiovascular risk in immune‐mediated inflammatory diseases: Tumour necrosis factor inhibitors compared to conventional therapies—A systematic review and meta‐analysis

Galajda,

Meznerics,

Mátrai

et al. 2024

Acad Dermatol Venereol

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Immune‐mediated inflammatory disease (IMID) patients including psoriasis, inflammatory arthritides and bowel diseases have a higher risk of developing cardiovascular (CV) diseases compared to the general population. The increased CV risk may be promoted by tumour necrosis factor (TNF)‐α‐mediated immunological processes, which are present both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional therapies in IMIDs. The systematic literature search was conducted in three databases (MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials, cohort and case–control studies were eligible for inclusion. Outcomes consisted of the incidence of CV events, with major adverse cardiovascular events (MACE) as a main endpoint. A random‐effects meta‐analysis was performed by pooling fully adjusted multivariate hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval (CI) comparing TNFis with conventional systemic non‐biologicals (CSNBs). Of a total of 8724 search results, 56 studies were included overall, of which 29 articles were eligible for the meta‐analysis, and 27 were involved in the systematic review. Including all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58–0.95, p = 0.025; IRR = 0.77, 95% CI 0.67–0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling IRRs also confirmed the significantly decreased risk of MACE in TNFi‐treated patients compared with CSNB groups (IRR = 0.79, 95% CI 0.64–0.98). The observational nature of most included studies leading to high heterogeneity represents a limitation. Based on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore, earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence may benefit CV risk in IMID patients.

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Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French population-based study

Richard,

Leroyer,

Ley

et al. 2024

Digestive and Liver Disease

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Patients with inflammatory bowel disease are at increased risk of atherothrombotic disease: A systematic review with meta-analysis

Cited by 12 publications

References 35 publications

Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study

Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study

Reducing cardiovascular risk in immune‐mediated inflammatory diseases: Tumour necrosis factor inhibitors compared to conventional therapies—A systematic review and meta‐analysis

Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French population-based study

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