Issue 18

Clinical Question

Do patients with IBD have a higher risk of cardiovascular disease than the general population?

Editor’s Bottom Line

IBD is associated with increased risks of acute myocardial infarction (AMI) and heart failure, and this risk is further increased by requirement for steroids.

Reference

Aniwan S, Pardi DS, Tremain WJ, Loftus EV. Increased Risk of Acute Myocardial Infarction and Heart Failure in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2018;16(10):1607–15.e1. https://doi.org/10.1016/j.cgh.2018.04.031

Synopsis

Studies examining the risk of cardiovascular disease among IBD patients have yielded mixed findings. Mayo Clinic researchers examined longitudinal medical record data from 339 patients with Crohn’s disease (CD) and 397 with ulcerative colitis (UC). Patients were diagnosed between 1980 and 2010 and included in the Rochester Epidemiology Project from Olmsted County, Minnesota and followed up for a total of 11,398 person-years. Their risk of cardiovascular disease was compared to 1,472 controls without an IBD diagnosis matched by age, gender, and index diagnosis date.

After correcting for known cardiovascular disease risk factors IBD was independently linked with a higher rate of AMI (adjusted hazard ratio [aHR]: 2.82; 95% Confidence Interval [CI]: 1.98–4.04) as well as heart failure (aHR: 2.03; 95% CI: 1.36–3.03).

Both CD patients (aHR: 2.89; 95% CI: 1.65–5.13) and UC patients (aHR: 2.70; 95% CI: 1.69–4.35) had a higher AMI risk and use of systemic corticosteroids further increased this risk for all IBD patients (aHR: 5.08; 95%: 3.00–8.81). Among CD patients, those with ileal/ileo-colonic disease and non-stricturing and non-fistulizing disease had the highest rates of AMI, while UC patients with proctitis/left-sided colitis and extensive colitis had higher rates of AMI. The cumulative probability of a first AMI from the time of IBD diagnosis was 3.2% at five years, 6.4% at 10 years and 12.3% at 20 years.

With respect to heart failure, the investigators found UC was associated with an increased risk (aHR: 2.06; 95% CI: 1.18–3.65) while CD was not. Systemic corticosteroid users had an increased risk of heart failure (aHR, 2.51; 95% CI, 1.93–4.57), while those without a history of corticosteroid use did not have a significantly raised risk. Female UC patients, those with extensive UC, and patients diagnosed after 40 years of age had the highest risks of heart failure. The cumulative probability of heart failure after IBD diagnosis was 2.2% at five years, 4.4% at 10 years and 8.5% at 20 years.

Details

Study Design: Retrospective longitudinal
Funding: Mayo Foundation for Medical Education and Research, the Rochester Epidemiology Project, and the National Institute on Aging of the National Institutes of Health
Allocation: Cohort
Setting: Database
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.