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Premature Atherosclerotic Cardiovascular Disease Risk Among Patients with Inflammatory Bowel Disease
Michelle T Lee1, Dhruv Mahtta2, Liang Chen1
1Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas; Section of Health Services Research, Department of Medicine.
Insights
Inflammatory bowel disease (IBD) is linked to a higher risk of premature atherosclerotic cardiovascular disease (ASCVD) in young adults. This association is stronger in younger patients and diminishes with age due to traditional risk factors.
Area of Science:
- Cardiology
- Gastroenterology
- Public Health
Background:
- Growing evidence links atherosclerotic cardiovascular disease (ASCVD) and inflammatory bowel disease (IBD) via chronic inflammation.
- Data on this association in young patients with premature ASCVD is limited.
Purpose of the Study:
- To investigate the association between IBD and premature ASCVD in young adults.
- To compare IBD prevalence in patients with premature ASCVD versus age-matched controls.
Main Methods:
- Utilized data from the Veterans with Premature Atherosclerosis (VITAL) registry.
- Assessed patients with premature (age ≤55) and extremely premature (age ≤40) ASCVD.
- Employed multivariable regression models adjusted for traditional cardiovascular risk factors.
Main Results:
- Higher IBD prevalence observed in premature (0.96%) and extremely premature (1.36%) ASCVD groups compared to controls.
- Adjusted odds ratios for IBD were 1.07 (95% CI, 1.00-1.14) for premature and 1.61 (95% CI, 1.34-1.94) for extremely premature ASCVD.
- The association was strongest for extremely premature ASCVD (age ≤40).
Conclusions:
- IBD is associated with increased odds of extremely premature ASCVD, particularly in individuals ≤40 years old.
- Traditional cardiometabolic factors attenuate this risk with increasing age.
- Further research is needed on early interventions to reduce cardiovascular risk in young IBD patients.
Background:
Recent literature has shown an association between atherosclerotic cardiovascular disease and inflammatory bowel disease, potentially mediated through chronic inflammatory pathways. However, there is a paucity of data demonstrating this relationship among young patients with premature atherosclerotic cardiovascular disease.
Methods:
Using data from the nationwide Veterans wIth premaTure AtheroscLerosis (VITAL) registry, we assessed the association between extremely premature and premature atherosclerotic cardiovascular disease (age at diagnosis: ≤40 years and ≤55 years, respectively) and inflammatory bowel disease. Patients were compared with age-matched controls without atherosclerotic cardiovascular disease. Multivariable regression models adjusted for traditional risk factors.
Results:
We identified 147,600 patients and 9485 patients with premature and extremely premature atherosclerotic cardiovascular disease, respectively. Compared with controls, there was a higher prevalence of overall inflammatory bowel disease among premature (0.96% vs 0.84%; odds ratio [OR] 1.14; 95% confidence interval [CI], 1.08-1.21) and extremely premature (1.36% vs 0.75%; OR 1.82; 95% CI, 1.52-2.17) patients. After adjustment, these associations attenuated in both premature and extremely premature groups (OR 1.07; 95% CI, 1.00-1.14 and OR 1.61; 95% CI, 1.34-1.94, respectively).
Conclusion:
Inflammatory bowel disease is associated with higher odds of extremely premature atherosclerotic cardiovascular disease, especially for those age ≤40 years. With increasing age, this risk is attenuated by traditional cardiometabolic factors such as obesity, hypertension, diabetes, smoking, and dyslipidemia. Prospective studies are needed to assess the role of early intervention to decrease cardiovascular risk among young patients with inflammatory bowel disease.
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