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Inflammatory bowel disease is associated with an increased incidence of cardiovascular events
Andres J Yarur1, Amar R Deshpande, David M Pechman
1Department of Medicine, University of Miami/Miller School of Medicine, Miami, FL, USA.
Insights
Patients with inflammatory bowel disease (IBD) have a higher risk of coronary artery disease (CAD) events, even with fewer traditional risk factors. Systemic inflammation and elevated white blood cell counts may contribute to this increased CAD risk.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Immunology
Background:
- Inflammatory bowel disease (IBD) is associated with systemic inflammation and hypercoagulability.
- Previous studies suggest a potential link between IBD and increased atherosclerosis risk.
- The incidence of coronary artery disease (CAD) and the influence of traditional risk factors in IBD patients are not well-defined.
Purpose of the Study:
- To compare the rates of CAD events in IBD patients versus matched controls.
- To investigate the role of traditional and nontraditional CAD risk factors in IBD patients.
Main Methods:
- A longitudinal cohort study design was employed, comparing IBD patients with matched controls.
- The primary outcome assessed was the incidence of CAD events.
- Cox proportional hazards models were utilized to analyze the impact of various risk factors on CAD development.
Main Results:
- The study included 356 IBD patients and 712 matched controls.
- IBD patients exhibited a significantly higher unadjusted hazard ratio (HR) for developing CAD (2.85).
- Despite having lower rates of traditional risk factors (hypertension, diabetes, dyslipidemia, obesity), IBD patients showed an adjusted HR of 4.08 for CAD. Elevated white blood cell (WBC) count emerged as a significant nontraditional risk factor in the IBD group (HR 1.23).
Conclusions:
- IBD patients experience an increased incidence of CAD events, irrespective of a lower burden of traditional risk factors.
- Traditional risk factors appear to have a diminished impact on CAD development in the context of IBD.
- Further research is needed to explore the role of nontraditional risk factors, such as WBC count, and the potential benefits of managing systemic inflammation in mitigating CAD risk in IBD patients.
Objectives:
Patients with inflammatory bowel disease (IBD) present with several extraintestinal manifestations, including systemic inflammation and hypercoagulability. Limited studies have shown that patients with IBD may have a higher risk of developing atherosclerosis. The incidence of coronary artery disease (CAD) and the role of traditional CAD risk factors in IBD patients remain unclear. We sought to compare the rates of CAD events in patients with IBD with matched controls.
Methods:
We performed a longitudinal cohort study of patients with IBD compared with matched controls. The primary outcome was the development of CAD events. Traditional and nontraditional CAD risk factors were assessed. Cox proportional hazards model was used to assess the impact of each CAD risk factor on the outcomes.
Results:
A total of 356 IBD patients and 712 matched controls were followed for a median of 53 and 51 months, respectively. The unadjusted hazard ratio (HR) for developing CAD in the IBD group was 2.85 (95% confidence interval (CI) 1.82-4.46). IBD patients had significantly lower rates of selected traditional CAD risk factors (hypertension, diabetes, dyslipidemia, and obesity; P<0.01 for all). Adjusting for these factors, the HR for developing CAD between groups was 4.08 (95% CI 2.49-6.70). Among nontraditional risk factors, an elevated white blood cell (WBC) count was a risk factor for CAD development in the IBD group (HR 1.23; 95% CI 1.15-1.33).
Conclusions:
An increased incidence of CAD events was noted in IBD patients despite having a lower burden of traditional risk factors. Additionally, these risk factors had a lower impact on CAD development in the IBD group. Further investigation into how nontraditional risk factors, including WBC count, and the effect of attenuating systemic inflammation in IBD patients change CAD risk is warranted.
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