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Long-term risk of arrhythmias in patients with inflammatory bowel disease: A population-based, sibling-controlled
Jiangwei Sun1, Bjorn Roelstraete1, Emma Svennberg2
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Insights
Patients with inflammatory bowel disease (IBD) face a higher long-term risk of developing arrhythmias, including atrial fibrillation and ventricular arrhythmias. This increased risk persists for at least 25 years post-diagnosis, highlighting the need for increased clinical awareness.
Area of Science:
- Gastroenterology and Cardiology
- Epidemiology of chronic diseases
- Inflammatory bowel disease (IBD) research
Background:
- Existing evidence suggests a link between inflammatory bowel disease (IBD) and cardiovascular disease (CVD).
- The specific association between IBD and the risk of developing arrhythmias remains unclear.
- This study investigates the long-term incidence of arrhythmias in patients diagnosed with IBD.
Purpose of the Study:
- To determine the long-term risk of developing arrhythmias in patients with Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U).
- To compare arrhythmia incidence in IBD patients with matched reference individuals and IBD-free siblings.
- To assess the persistence of arrhythmia risk over time following IBD diagnosis.
Main Methods:
- Utilized a nationwide Swedish histopathology cohort (1969-2017) to identify patients with biopsy-confirmed IBD (CD, UC, IBD-U) and matched controls.
- Employed flexible parametric survival models to estimate adjusted hazard ratios (aHR) for overall and specific arrhythmias.
- Conducted sibling comparison analyses to confirm findings and adjusted for numerous demographic and clinical covariates.
Main Results:
- Patients with CD, UC, and IBD-U exhibited significantly increased risks of overall arrhythmias compared to reference individuals (aHRs ranging from 1.14 to 1.30).
- The elevated risk of arrhythmias persisted for 25 years post-diagnosis, with specific types like atrial fibrillation and ventricular arrhythmias being more common.
- Sibling analyses corroborated the increased arrhythmia risk associated with IBD, with the exception of bradyarrhythmias.
Conclusions:
- Patients diagnosed with IBD have a significantly elevated long-term risk of developing various arrhythmias.
- This increased risk is sustained for at least 25 years after the initial IBD diagnosis.
- Healthcare professionals should maintain heightened awareness of the cardiovascular implications, specifically arrhythmias, in patients with IBD.
Background:
Although previous evidence has suggested an increased risk of cardiovascular disease (CVD) in patients with inflammatory bowel disease (IBD), its association with arrhythmias is inconclusive. In this study, we aimed to explore the long-term risk of arrhythmias in patients with IBD.
Methods And Findings:
Through a nationwide histopathology cohort, we identified patients with biopsy-confirmed IBD in Sweden during 1969 to 2017, including Crohn's disease (CD: n = 24,954; median age at diagnosis: 38.4 years; female: 52.2%), ulcerative colitis (UC: n = 46,856; 42.1 years; 46.3%), and IBD-unclassified (IBD-U: n = 12,067; 43.8 years; 49.6%), as well as their matched reference individuals and IBD-free full siblings. Outcomes included overall and specific arrhythmias (e.g., atrial fibrillation/flutter, bradyarrhythmias, other supraventricular arrhythmias, and ventricular arrhythmias/cardiac arrest). Flexible parametric survival models estimated hazard ratios (aHR) with 95% confidence intervals (95% CIs), after adjustment for birth year, sex, county of residence, calendar year, country of birth, educational attainment, number of healthcare visits, and cardiovascular-related comorbidities. Over a median of approximately 10 years of follow-up, 1,904 (7.6%) patients with CD, 4,154 (8.9%) patients with UC, and 990 (8.2%) patients with IBD-U developed arrhythmias, compared with 6.7%, 7.5%, and 6.0% in reference individuals, respectively. Compared with reference individuals, overall arrhythmias were increased in patients with CD [54.6 versus 46.1 per 10,000 person-years; aHR = 1.15 (95% CI [1.09, 1.21], P < 0.001)], patients with UC [64.7 versus 53.3 per 10,000 person-years; aHR = 1.14 (95% CI [1.10, 1.18], P < 0.001)], and patients with IBD-U [78.1 versus 53.5 per 10,000 person-years; aHR = 1.30 (95% CI [1.20, 1.41], P < 0.001)]. The increased risk persisted 25 years after diagnosis, corresponding to 1 extra arrhythmia case per 80 CD, 58 UC, and 29 IBD-U cases over the same period. Patients with IBD also had a significantly increased risk of specific arrhythmias, except for bradyarrhythmias. Sibling comparison analyses confirmed the main findings. Study limitations include lack of clinical data to define IBD activity, not considering the potential role of IBD medications and disease activity, and the potential residual confounding from unmeasured factors for arrhythmias.
Conclusions:
In this study, we observed that patients with IBD were at an increased risk of developing arrhythmias. The excess risk persisted even 25 years after IBD diagnosis. Our findings indicate a need for awareness of this excess risk among healthcare professionals.
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