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Effect of Inflammatory Bowel Disease-Related Characteristics and Treatment Interventions on Cardiovascular Disease
Sudeep D Thapa1, Hiba Hadid, Jason Schairer
1Departments of Internal Medicine (SDT, HH, WI) and Gastroenterology (JS, SMJ), Henry Ford Hospital, Madison Heights, Michigan.
Insights
Inflammatory bowel disease (IBD) patients treated with thiopurines had fewer cardiovascular events, while those on tumor necrosis factor alpha antagonists experienced more. This highlights how IBD treatments impact heart health.
Area of Science:
- Gastroenterology and Cardiology
- Investigating the interplay between inflammatory bowel disease and cardiovascular health.
Background:
- Established association between inflammatory bowel disease (IBD) and cardiovascular diseases (CVD).
- Limited understanding of how IBD-specific factors influence cardiovascular event risk.
Purpose of the Study:
- To examine the relationship between IBD characteristics and the occurrence of cardiovascular events.
- To identify specific IBD treatments associated with cardiovascular outcomes.
Main Methods:
- Retrospective, nested case-control study of IBD patients (2000-2004) with 10-year follow-up.
- 111 cases (cardiovascular events) and 222 controls, matched for Framingham cardiovascular risk score.
- Conditional logistic regression used to assess predictor variables and cardiovascular outcomes.
Main Results:
- Thiopurine treatment was linked to a decreased risk of cardiovascular events (OR: 0.42, P=0.02).
- Tumor necrosis factor alpha antagonist use was associated with an increased risk of cardiovascular events (OR: 2.63, P=0.001).
- Disease-related surgery and hospitalization showed non-significant trends towards decreased and increased cardiovascular events, respectively.
Conclusions:
- Thiopurine therapy in IBD patients is associated with a reduced incidence of cardiovascular diseases.
- Treatment with tumor necrosis factor alpha antagonists correlates with a higher incidence of cardiovascular outcomes in IBD patients.
Background:
An association between inflammatory bowel disease (IBD) and cardiovascular diseases has been shown in multiple studies. However, little is known about the effect of IBD-related characteristics on cardiovascular events.
Methods:
The authors conducted a retrospective, nested case-control study of IBD patients who presented to the institution from 2000 to 2004, allowing for a 10-year follow-up period. One hundred eleven patients who developed cardiovascular events (cases) and 222 patients who did not develop cardiovascular events (cases) were included in the study after matching for Framingham cardiovascular risk score (2008). Relationships between predictor variables and cardiovascular outcome were assessed by conditional logistic regression.
Results:
The cases and controls were similar in age, gender, smoking and cholesterol level. There was no difference in disease subtype (ulcerative colitis or Crohn's disease). On conditional logistic regression, thiopurine treatment (odds ratio [OR]: 0.42, 95% confidence interval [CI]: 0.19-0.87; P = 0.02) was associated with decreased cardiovascular events and tumor necrosis factor alpha antagonist use (OR: 2.63, 95% CI: 1.49-4.63; P = 0.001) was associated with increased cardiovascular events. Although not statistically significant, disease-related surgery (OR: 0.57, 95% CI: 0.32-1.02; P = 0.06) was associated with decreased cardiovascular events and disease-related hospitalization (OR: 1.58, 95% CI: 0.96-2.57; P = 0.07) was associated with increased incidence of cardiovascular disorders.
Conclusions:
The authors observed decreased incidence of cardiovascular diseases in patients with IBD who were treated with thiopurines and increased incidence of cardiovascular outcomes among patients treated with tumor necrosis factor alpha antagonist.
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