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Risk of Ischaemic Heart Disease in Patients with Inflammatory Bowel Disease: Cohort Study Using the General Practice
Helen Close1, James M Mason1, Douglas W Wilson1
1School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, United Kingdom.
Insights
Ischaemic heart disease (IHD) prevalence is higher in patients with inflammatory bowel disease (IBD), but most IHD diagnoses occur before IBD diagnosis. This suggests a complex relationship between IBD and IHD beyond shared inflammation.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Epidemiology
Background:
- Inflammatory bowel disease (IBD) shares inflammatory pathways with ischaemic heart disease (IHD).
- The precise association between IBD and IHD remains unclear.
- Understanding this relationship is crucial for patient management.
Purpose of the Study:
- To investigate the extent and direction of the association between IBD and IHD.
- To determine if IBD increases the risk of developing IHD.
Main Methods:
- Retrospective cohort study using the General Practice Research Database (1987-2009).
- Matched 19,163 IBD patients (≥15 years) with 75,735 controls without IBD.
- Primary outcome: hazard ratio for IHD.
Main Results:
- Higher IHD prevalence in IBD patients (11.6%) versus controls (8.6%).
- Majority of IHD diagnoses (51.5%) preceded IBD diagnosis.
- Increased IHD risk observed in the first year post-IBD diagnosis, particularly for Ulcerative Colitis (UC) patients.
Conclusions:
- While IHD prevalence is higher in IBD patients, most IHD diagnoses occur before IBD.
- The relationship between IBD and IHD is more complex than a simple inflammatory link.
- Alternative etiological models for IHD in IBD patients should be explored.
Objective:
Patients with inflammatory bowel disease (IBD) demonstrate an inflammatory response which bears some similarities to that seen in ischaemic heart disease (IHD). The nature of the association of IBD with IHD is uncertain. We aimed to define the extent and direction of that association.
Design:
This retrospective cohort study examined records from patients aged ≥ 15 years with IBD from 1987-2009 (n = 19163) who were age and gender matched with patients without IBD (n = 75735) using the General Practice Research Database. The primary outcome was the hazard ratio for IHD.
Results:
A higher proportion of IBD patients had a recorded diagnosis of IHD ever, 2220 (11.6%) compared with 6504 (8.6%) of controls. However, the majority (4494, 51.5%) developed IHD prior to IBD diagnosis (1404 (63.2%) of IBD cases and 3090 (47.5%) of controls). There was increased IHD incidence in the first year after IBD diagnosis. Mean age at IHD diagnosis was statistically similar across all IBD groups apart from for those with Ulcerative Colitis (UC) who were slightly younger at diagnosis of angina compared to controls (64.5y vs. 67.0y, p = 0.008) and coronary heart disease (65.7y vs.67.9y, p = 0.015). Of those developing IHD following IBD diagnosis, UC patients were at higher risk of IHD (unadjusted HR 1.3 (95% CI 1.1-1.5), p<0.001) or MI (unadjusted HR 1.4 (95% CI 1.1-1.6), p = 0.004).
Conclusion:
Although IHD prevalence was higher in IBD patients, most IHD diagnoses predated the diagnosis of IBD. This implies a more complex relationship than previously proposed between the inflammatory responses associated with IHD and IBD, and alternative models should be considered.
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