Time‐dependent incidence and risk for myocardial infarction in patients with alcoholic cirrhosis

Abstract

Background It remains unsettled whether alcoholic cirrhosis is a risk factor for myocardial infarction (MI). Methods We used data from nationwide healthcare registries to study all Danes diagnosed with alcoholic cirrhosis in 1996‐2014, and five controls were matched to each of them on gender and age. We excluded everyone with ischaemic heart disease and used Cox regression to estimate the incidence rate ratio of MI adjusted for potential cardiovascular confounders. Further, we described the MI‐risk with non‐MI death as a competing risk. Results We included 22 867 patients (67% men) with a median age of 57 years. During the first year of follow‐up, their incidence rate ratio of MI was increased to 1.24 (95% CI: 0.94‐1.62), driven by the effect among women (2.13, 95% CI: 1.17‐3.87) and those with most severe cirrhosis (1.32, 95% CI: 0.91‐1.90). After the first year, the overall incidence rate ratio fell to (0.89, 95% CI: 0.76‐1.05). Patients were more likely to die from non‐MI causes (33.7% vs 1.0%), which protected them against MI. The overall 1‐year MI‐risk was similar in patients and controls: 0.38% (95% CI: 0.30‐0.47%) vs 0.34% (95% CI: 0.31‐0.38%). After five years of follow‐up, male patients had lower MI‐risk than their controls, whereas women with cirrhosis had an increased MI‐risk throughout follow‐up. Conclusions The incidence rate of MI was increased the first year following a diagnosis of alcoholic cirrhosis, in particular in women and those with most severe liver disease. Due to the competing risk of non‐MI mortality, the MI‐risk was not increased.

Risk and Outcome of Venous and Arterial Thrombosis in Patients With Cirrhosis: A Danish Nation‐wide Cohort Study

“…We found that cirrhosis was not a risk factor for AMI. This finding is consistent with our previous study, ( 9 ) and here we show that—among patients with cirrhosis—decompensation was a strong risk factor for AMI. We also extend our previous study by highlighting that AMI is highly fatal in patients with cirrhosis.…”

“…We have found that patients with cirrhosis have more severe and extensive coronary artery disease than controls, ( 8 ) yet they do not have an increased risk of acute myocardial infarction (AMI). ( 9 ) In addition, a recent meta‐analysis found no apparent association between cirrhosis and risk of ischemic stroke (IS), but all five meta‐analyzed studies were from Asia, and relative risks ranged from 0.32 to 1.22. ( 10 ) Thus, risks of AMI and IS in patients with cirrhosis remain poorly defined.…”

“…(5)(6)(7) Although existing studies provide estimates of the relative risk of venous thrombosis for patients with cirrhosis, the absolute risk, which is a key metric for informing the need for intervention, is open for study.We have found that patients with cirrhosis have more severe and extensive coronary artery disease than controls, (8) yet they do not have an increased risk of acute myocardial infarction (AMI). (9) In addition, a recent meta-analysis found no apparent association between cirrhosis and risk of ischemic stroke (IS), but all five meta-analyzed studies were from Asia,…”

Atrial fibrillation, liver cirrhosis, thrombosis, and bleeding: A Danish population‐based cohort study

“…They found that patients with liver cirrhosis had an increased risk of ischemic stroke (aHR, 1.7; 95% CI, 1.3‐2.3) and venous thromboembolism (aHR, 2.0; 95% CI, 1.5‐2.6), but not myocardial infarction (aHR, 0.7; 95% CI, 0.5‐0.9). Similar findings on the lack of association between liver cirrhosis and myocardial infarction are described by Deleuran et al 37 …”

“…CI, confidence interval; HR, hazard ratio TA B L E 3 Incidence rates, number of events, and adjusted hazard ratios of thromboembolic and bleeding complications, during 0-1 year of follow-up, stratified by baseline values, in patients with atrial fibrillation or flutter ), but not myocardial infarction (aHR, 0.7; 95% CI, 0.5-0.9). Similar findings on the lack of association between liver cirrhosis and myocardial infarction are described by Deleuran et al 37 Søgaard et al 13 investigated the risk of venous thromboembolism in patients with liver cirrhosis, compared to the general population.…”