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Increased Risk of Acute Coronary Syndrome in Patients With Diverticular Disease: A Nationwide Population-Based Study
Jiun-Nong Lin1, Cheng-Li Lin, Chih-Hui Yang
1From the Department of Critical Care Medicine (JNL), Division of Infectious Diseases, Department of Internal Medicine (JNL, CHL, HHL), Department of Nuclear Medicine (MCL), E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan (JNL), Management Office for Health Data (CLL), Department of Nuclear Medicine and PET Center (CHK), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine (CHK), College of Medicine, China Medical University, Taichung, Taiwan (CLL); and General Education Center, Meiho University, Pingtung, Taiwan (CHY).
Insights
Patients with diverticular disease have a significantly higher risk of developing acute coronary syndrome (ACS). This large population study highlights a potential link between these common conditions, underscoring the need for further investigation into underlying mechanisms.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Epidemiology
Background:
- Diverticular disease and acute coronary syndrome (ACS) are prevalent conditions.
- Shared risk factors exist between diverticular disease and ACS.
- The association between diverticular disease and ACS risk remains underexplored.
Purpose of the Study:
- To investigate the association between diverticular disease and the risk of developing ACS.
- To quantify the risk of ACS in individuals diagnosed with diverticular disease.
Main Methods:
- A nationwide retrospective cohort study utilizing Taiwan's National Health Insurance Research Database.
- Inclusion of patients aged ≥20 years diagnosed with diverticular disease (2000-2011).
- Matching of patients with diverticular disease to a control group without the condition (4:1 ratio) based on age, sex, and diagnosis year; exclusion of patients with prior cardiovascular disease.
Main Results:
- The study included 52,681 patients with diverticular disease and 210,724 controls.
- Patients with diverticular disease exhibited a higher incidence density of ACS (45.5 per 10,000 person-years) compared to controls (30.3 per 10,000 person-years).
- An adjusted hazard ratio (HR) of 1.23 (95% CI, 1.14-1.32) indicated a significantly increased risk of ACS in patients with diverticular disease, with risk escalating with the number of comorbidities.
Conclusions:
- Diverticular disease is associated with an increased risk of acute coronary syndrome.
- The findings suggest a significant link between diverticular disease and cardiovascular events.
- Further research is recommended to elucidate the specific mechanisms connecting diverticular disease and ACS.
Abstract:
Diverticular disease and acute coronary syndrome (ACS) are common disorders that share several risk factors. Few researchers have evaluated the association between diverticular disease and ACS. We aimed to assess the risk of ACS in patients with diverticular disease. A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. All patients aged ≥20 years with a diagnosis of diverticular disease from January 1, 2000, to December 31, 2011, were included in this study. For comparison, patients without diverticular disease were randomly selected and matched with the study cohort at a 4:1 ratio according to age, sex, and the year of the diagnosis of diverticular disease. Patients with incomplete age or sex information and a history of cardiovascular diseases were excluded from the study. All patients were followed until an ACS event, withdrawal from the insurance program, or December 31, 2011. In this study, 52,681 patients with diverticular disease and 210,724 patients without diverticular disease were included. Men accounted for 56.1% of patients and 57.8% of patients were ≥50 years old. The overall incidence density of ACS in patients with diverticular disease (45.5 per 10,000 person-years) was significantly higher than in those without diverticular disease (30.3 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.23 (95% confidence interval [CI], 1.14-1.32) after adjustment for age, sex, and comorbidities. The cumulative incidence of ACS in patients with diverticular disease was significantly higher than that in the control cohort (log-rank test, P < 0.001). The adjusted HRs for the development of ACS were 1.25 (95% CI, 1.15-1.37) and 1.19 (95% CI, 1.07-1.32) in patients with diverticulitis and diverticulosis, respectively. The adjusted HRs of ACS in patients with diverticular disease additionally increased from 1.97 (95% CI, 1.73-2.23) in patients with 1 comorbidity to 5.51 (95% CI, 3.88-7.84) in those with ≥5 comorbidities. This large population-based retrospective study revealed an association between diverticular disease and ACS. Further research is warranted to determine the exact mechanism of the link between these diseases.
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