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Patients With Microscopic Colitis Are at Higher Risk of Major Adverse Cardiovascular Events: A Matched Cohort Study
Anders Forss1, David Bergman2, Bjorn Roelstraete2
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Background And Aims:
Inflammatory diseases are associated with an increased risk of incident major adverse cardiovascular events (MACE). However, data on MACE are lacking in large population-based histopathology cohorts of microscopic colitis (MC).
Methods:
This study included all Swedish adults with MC without previous cardiovascular disease (1990-2017; N = 11,018). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded intestinal histopathology reports from all pathology departments (n = 28) in Sweden. MC patients were matched for age, sex, calendar year, and county with up to 5 reference individuals (N = 48,371) without MC or cardiovascular disease. Sensitivity analyses included full sibling comparisons, and adjustment for cardiovascular medication and healthcare utilization. Multivariable-adjusted hazard ratios for MACE (any of ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality) were calculated using Cox proportional hazards modelling.
Results:
Over a median of 6.6 years of follow-up, 2181 (19.8%) incident cases of MACE were confirmed in MC patients and 6661 (13.8%) in reference individuals. MC patients had a higher overall risk of MACE outcomes compared with reference individuals (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.21-1.33) and higher risk of its components: ischemic heart disease (aHR, 1.38; 95% CI, 1.28-1.48), congestive heart failure (aHR, 1.32; 95% CI, 1.22-1.43), and stroke (aHR, 1.12; 95% CI, 1.02-1.23) but not cardiovascular mortality (aHR, 1.07; 95% CI, 0.98-1.18). The results remained robust in the sensitivity analyses.
Conclusions:
Compared with reference individuals, MC patients had a 27% higher risk of incident MACE, equal to 1 extra case of MACE for every 13 MC patients followed for 10 years.
Insights
Microscopic colitis (MC) patients face a significantly higher risk of major adverse cardiovascular events (MACE), including heart disease and stroke. This finding highlights the importance of cardiovascular monitoring in individuals with microscopic colitis.
Area of Science:
- Gastroenterology and Cardiology
- Inflammatory Bowel Disease Research
- Public Health and Epidemiology
Background:
- Inflammatory diseases are linked to increased cardiovascular risk.
- Large-scale data on major adverse cardiovascular events (MACE) in microscopic colitis (MC) cohorts are limited.
Purpose of the Study:
- To investigate the association between microscopic colitis and the risk of incident major adverse cardiovascular events (MACE).
- To quantify the cardiovascular risk in a large, population-based cohort of Swedish adults diagnosed with MC.
Main Methods:
- A nationwide cohort study of 11,018 Swedish adults with MC (1990-2017), matched with 48,371 reference individuals.
- MC diagnosis confirmed via histopathology; MACE included ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality.
- Cox proportional hazards modeling used to calculate multivariable-adjusted hazard ratios, with sensitivity analyses including sibling comparisons.
Main Results:
- MC patients exhibited a 27% higher overall risk of MACE (aHR, 1.27; 95% CI, 1.21-1.33) compared to controls.
- Increased risks were observed for ischemic heart disease (aHR, 1.38), congestive heart failure (aHR, 1.32), and stroke (aHR, 1.12).
- No significant increase in cardiovascular mortality risk was found (aHR, 1.07).
Conclusions:
- Microscopic colitis is associated with a significantly elevated risk of incident major adverse cardiovascular events.
- The findings suggest a need for increased cardiovascular surveillance in patients diagnosed with microscopic colitis.
- One additional MACE case occurs for every 13 MC patients followed for 10 years.
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