Issue 16

Clinical Question

Is IBD a risk factor for myocardial infarction?

Editor’s Bottom Line

Patients with inflammatory bowel disease could benefit from our attention to modifiable cardiovascular risk factors.

Reference

Panhwar MS, Mansoor E, Al-Kindi SG, et al. Risk of Myocardial Infarction in Inflammatory Bowel Disease: A Population-based National Study. Inflamm Bowel Dis. 2019;25(6):1080–87; https://doi.org/10.1093/ibd/izy354

Synopsis

To shed light on the association between IBD and myocardial infarction (MI), researchers at the Cleveland Medical Center reviewed data from 29,090,220 patient records included in a commercial database of 26 health care systems in the United States. They identified 131,680 adults with ulcerative colitis (UC) and 158,750 with Crohn’s disease (CD) with follow-up over a five-year period.

Findings showed the five-year prevalence of MI was 6.7% among UC patients and 8.8% among CD patients, compared to 3.3% among patients without IBD, yielding more than a two-fold increase in the odds of MI for those with UC (Odds ratio: 2.09; 95% Confidence Interval [CI]: 2.04–2.13; P<0.05) and an even higher risk among CD patients (OR: 2.79; 95% CI: 2.74–2.85; P<0.05). However, they noted common cardiovascular risk factors were also more common among IBD patients.

IBD patients aged 30–34 had the highest relative increase in risk of MI (OR: 12.05; 95% CI: 11.16–13.01), and this dropped with age (OR for 65 years of age or older: 2.08; 95% CI: 2.04–2.11; P<0.05).

Multivariate analysis controlling for age, race, sex, and known cardiovascular risk factors, such as dyslipidemia, diabetes, hypertension, smoking and obesity, suggested that IBD itself is an independent risk factor for MI (OR: 1.25; 95% CI: 1.24–1.27; P<0.0001).

The authors said the findings require validation in a prospective study, but the results highlight the need to aggressively manage cardiovascular risk factors in IBD patients.

Details

Study Design: Retrospective population-based
Funding: Not disclosed
Allocation: Not applicable
Setting: Multicenter 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.