Inflammatory bowel disease raises risk of acute arterial events

Last Updated: 2017-08-04

By Marilynn Larkin

NEW YORK (Reuters Health) - Patients with inflammatory bowel disease (IBD) are at increased risk of ischemic heart, cardiovascular and peripheral artery disease events, with the highest risk in those under age 55, researchers say.

"While IBD is associated with systemic inflammation and systemic inflammation is associated with atherosclerosis, the magnitude and independent drivers of the risk of acute arterial events in IBD are still unclear," Dr. Julien Kirchgesner of Sainte-Antoine Hospital in Paris, France, told Reuters Health by email.

To investigate, Dr. Kirchgesner and colleagues analyzed French hospital discharge data from 2008 to 2013 on IBD patients over age 15. About 98,000 had Crohn's disease (median age, 40; 57.7% female), and about 112,000 had ulcerative colitis (median age, 49; 50.5% female).

Patients were followed until the first acute arterial event (median followup, 3.4 years), defined as a primary discharge diagnosis or procedures related to ischemic heart disease (including myocardial infarction), cerebrovascular disease (including stroke), and peripheral artery disease (except for acute mesenteric ischemia).

As reported online July 25 in Gut, 5,554 acute arterial events occurred during follow-up: 57.2% related to ischemic heart disease, 30.9% to cerebrovascular disease, and 11.9% to peripheral artery disease.

Crohn's disease and ulcerative colitis patients both had a statistically significant overall increased risk of acute arterial events. Crohn's patients age 15 to 54 were at highest risk. The magnitude of the risk decreased after age 55 but remained statistically significant.

Ulcerative colitis patients age 15 to 34 were at highest risk for an acute arterial event, whereas individuals age 55 to 74 were also at increased risk, but to a lesser extent. Patients age 35 to 54 and those age 75 or older were not at increased risk.

Compared with the general population, women with IBD were at higher risk than men for all arterial disease groups, with the highest risk specifically in women with Crohn's.

Disease activity was associated with an increased risk of acute arterial events (HR, 1.74) in Crohn's disease patients. The increased risk was statistically significant for all arterial disease groups, and the magnitude of risk was highest for peripheral artery disease.

Disease activity was also associated with an increased risk of acute arterial events in ulcerative colitis patients (HR, 1.87), but the risk of cerebrovascular disease events was not statistically significant.

All patients were at increased risk of acute arterial events in the three-month periods before and after an IBD-related hospitalization.

"This study supports the concept that a tight control of inflammation is crucial in patients with IBD to avoid IBD-related systemic complications," Dr. Kirchgesner said by email. "The impact of therapies, including anti-TNFs, still has to be addressed."

Gastroenterologist Dr. Louis Cohen of The Mount Sinai Hospital in New York City told Reuters Health, "It has long been established that patients with IBD are at an increased risk of venous thrombotic disease, but the effect on arterial thrombosis has been somewhat inconclusive."

"This is a well-designed study, the results of which should be taken seriously by the IBD community, though as with all database studies, it must be interpreted cautiously due to a reliance on ICD coding, which is notoriously flawed," he said by email.

"The study brings up important questions for patients with IBD and physicians who treat them," he noted. He added that it is now standard to anticoagulate IBD patients with venous thrombotic disease during a hospitalization, and that some clinicians believe anticoagulation should continue after discharge, when the patient may still be at risk of thrombosis.

"If the results of this study are supported in other large database cohorts, it could be imagined that IBD would be considered a risk factor for cardiovascular disease," he suggested, "and patients would be treated similarly to other high-risk populations that receive medical prophylaxis (aspirin) as well as aggressive modification of cardiovascular risk factors."

SOURCE: http://bit.ly/2wecedK

Gut 2017. (Reporting by Steven DeMaio)