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Long-term Risk of Stroke in Patients With Inflammatory Bowel Disease: A Population-Based, Sibling-Controlled Cohort
Jiangwei Sun1, Jonas Halfvarson2, Peter Appelros2
1From the Department of Medical Epidemiology and Biostatistics (J.S., D.B., F.E., B.R., J.F.L.), Karolinska Institutet, Stockholm; Department of Gastroenterology (J.H.), and University Health Care Research Center (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Gastroenterology and Hepatology (F.E.), Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland; Clinical Epidemiology Division (O.O.), Department of Medicine Solna, Karolinska Institutet, Stockholm; Sachs' Children and Youth Hospital (O.O.), Stockholm South General Hospital; Department of Clinical Science and Education Södersjukhuset (O.O.), Karolinska Institutet, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; and Division of Digestive and Liver Disease (J.F.L.), Department of Medicine, Columbia University Medical Center, New York, NY. jiangwei.sun@ki.se.
Patients with inflammatory bowel disease (IBD) have a higher long-term risk of stroke, particularly ischemic stroke, across all subtypes. This increased risk persists for at least 25 years post-diagnosis, emphasizing the need for ongoing monitoring.
Area of Science:
- Gastroenterology
- Neurology
- Epidemiology
Background:
- Inflammatory bowel disease (IBD) is linked to increased thromboembolic events.
- Long-term stroke risk in IBD patients requires further investigation.
Purpose of the Study:
- To determine if biopsy-confirmed IBD increases the long-term risk of stroke.
- To analyze stroke risk across different IBD subtypes and compare it to matched controls and siblings.
Main Methods:
- A Swedish cohort study (1969-2019) included 85,006 IBD patients and matched controls/siblings.
- Stroke outcomes (overall, ischemic, hemorrhagic) were identified via the National Patient Register.
- Flexible parametric survival models estimated adjusted hazard ratios (aHRs).
Main Results:
- IBD patients had a 13% higher risk of overall stroke (aHR 1.13) compared to references.
- The elevated risk, primarily from ischemic stroke, persisted for 25 years.
- Increased ischemic stroke risk was observed across Crohn's disease, ulcerative colitis, and IBD-unclassified.
Conclusions:
- Patients with IBD face a significantly increased long-term risk of stroke, especially ischemic events.
- This risk is consistent across IBD subtypes and persists for decades.
- Clinical vigilance for cerebrovascular events is crucial in long-term IBD management.
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