Disease activity in inflammatory bowel disease is associated with arterial vascular disease

Card, Timothy R; Zittan, Eran; Nguyen, Geoffrey C.; Grainge, Matthew J

Abstract

Background and Aims: There is evidence that several inflammatory diseases are associated with increased cardiovascular risk. Whether this is true for inflammatory bowel diseases remains controversial. We aimed to assess this risk corrected for the effects of conventional vascular risk factors, and IBD disease activity.

Methods: We conducted a cohort study in British general practice and hospital records from the Clinical Practice Research Datalink. We extracted the records of subjects with IBD and matched controls from 1997 to 2017. We conducted Cox proportional hazards and self-controlled case series analyses to examine the associations of IBD, disease activity and hospitalisation with the risk of myocardial infarction, stroke and cardiovascular death in a manner attempting to remove the effect of likely confounders.

Results: We identified 31,175 IBD patients (16,779 UC, 10,721 Crohn’s disease and 3,675 unclassifiable cases) and 154,412 matched controls. 532 myocardial infarctions, 555 strokes and 469 cardiovascular deaths were observed in IBD cases. Our Cox regression models adjusted for potential confounders, showed no significant excess of vascular events for IBD patients overall. There was however an increased hazard of MI in ambulatory patients for acute disease (Hazard Ration 1.83 (1.28-2.62)) and chronic activity (Hazard Ratio 1.69 (1.24-2.30)). This effect of disease activity was confirmed in our case series analysis.

Conclusions:Though we have found no evidence of an overall excess of vascular events in IBD patients, our findings of increased risk with more active disease suggest the potential for anti-inflammatory therapies to reduce cardiovascular risk in this patient group.

Citation

Card, T. R., Zittan, E., Nguyen, G. C., & Grainge, M. J. (2021). Disease activity in inflammatory bowel disease is associated with arterial vascular disease. Inflammatory Bowel Diseases, 27(5), 629–638. https://doi.org/10.1093/ibd/izaa156

• Journal Article Type: Article
• Acceptance Date: May 22, 2020
• Online Publication Date: Jul 3, 2020
• Publication Date: 2021-05
• Deposit Date: May 27, 2020
• Publicly Available Date: Jul 4, 2021
• Journal: Inflammatory Bowel Diseases
• Print ISSN: 1078-0998
• Electronic ISSN: 1536-4844
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 5
• Pages: 629–638
• DOI: https://doi.org/10.1093/ibd/izaa156
• Keywords: IBD, epidemiology, vascular disease
• Public URL: https://nottingham-repository.worktribe.com/output/4517187
• Publisher URL: https://academic.oup.com/ibdjournal/article-abstract/doi/10.1093/ibd/izaa156/5866856?redirectedFrom=fulltext
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Inflammatory Bowel Diseases following peer review. The version of record Timothy R Card, PhD, FRCP, Eran Zittan, MD, Geoffrey C Nguyen, MD, PhD, FRCPC, Matthew J Grainge, PhD, Disease Activity in Inflammatory Bowel Disease Is Associated With Arterial Vascular Disease, Inflammatory Bowel Diseases, is available online at: https://doi.org/10.1093/ibd/izaa156