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The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National
Sara Ghoneim1, Aun Shah1, Aneesh Dhorepatil1
1Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA.
Insights
Inflammatory bowel disease (IBD) significantly increases the risk of cerebrovascular accidents (CVA), even after accounting for traditional risk factors. This study highlights IBD as an independent risk factor for CVA, necessitating further research into underlying mechanisms.
Area of Science:
- Neurology
- Gastroenterology
- Public Health
Background:
- Inflammatory bowel disease (IBD) is linked to cardiovascular events, but its association with cerebrovascular accidents (CVA) is unclear.
- Proposed mechanisms include hypercoagulability and systemic inflammation in IBD patients.
Purpose of the Study:
- To determine the risk of CVA in patients diagnosed with IBD compared to those without IBD.
- To assess CVA risk in IBD patients considering established risk factors.
Main Methods:
- Analysis of a large commercial healthcare database (Explorys, IBM) from 26 health systems.
- Identification of adult IBD patients (ulcerative colitis, Crohn's disease) from September 1994 to September 2019.
- Multivariable logistic regression adjusting for age, diabetes, hypertension, female gender, and atrial fibrillation to evaluate CVA risk.
Main Results:
- The study included over 52 million patients, with 261,890 diagnosed with IBD.
- Prevalence of CVA was substantially higher in IBD patients (6.24%) versus non-IBD patients (0.48%).
- IBD patients had 13.7 times higher odds of CVA (univariate) and 8.07 times higher odds (multivariate) after adjusting for confounders.
Conclusions:
- Inflammatory bowel disease (IBD) is identified as an independent risk factor for cerebrovascular accidents (CVA).
- Further research is required to elucidate the mechanisms linking IBD to increased CVA risk.
- Findings suggest potential for early identification and intervention strategies for CVA in IBD patients.
Background:
Inflammatory bowel disease (IBD) has been associated with an increased risk of cardiovascular events, but the risk of cerebrovascular accidents (CVA) remains unknown. Hypercoagulability and systemic inflammation are two proposed mechanisms by which the presence of IBD might lead to the development of CVA.
Objective:
To assess the risk of CVA in patients with IBD compared to those without IBD with known traditional risk factors for CVA.
Methods:
We reviewed data from a large commercial database (Explorys, IBM) that aggregated records from 26 health-care systems nationwide. Using systemized nomenclature of medicine - clinical terms, we identified adult patients diagnosed with IBD (ulcerative colitis or Crohn's disease) between September 1994 and September 2019. We then examined the risk of CVA in these patients. Known risk factors such as age ≥65-years old, diabetes mellitus (DM), hypertension (HTN), female gender, atrial fibrillation (Afib) were collected. A univariate binary logistic model was constructed using CVA as the dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates was created to test for CVA.
Results:
A total of 52,176,550 patients were included in this analysis, and 261,890 had IBD. The prevalence of CVA was higher in IBD patients compared to non-IBD patients (6.24% versus 0.48%, p <0.0001). The univariate binary logistic regression showed 13.7 times higher odds of having CVA in IBD patients than without IBD (odds ratio (OR) 13.74, p <0.0001). In multivariate binary logistic regression, after adjusting for traditional risk factors for CVA (Afib, HTN, female gender, DM, age ≥65 years), odds ratio of CVA in IBD patients remained significantly higher (OR 8.07, 95% CI: 7.9-8.2, p<0.0001).
Conclusion:
In our large cohort of patients, IBD appears to be an independent risk factor for CVA. Further prospective studies are needed to understand the underlying mechanisms by which IBD increases the risk of CVA. This may lead to early identification and intervention to reduce the risk of CVA in this highly heterogeneous group of patients.
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