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Association between inflammatory bowel disease and risk of stroke: a systematic review and meta-analysis of cohort
Jin-Shan Fan1, Meng Wang2, Ni Chen3
1Department of Intensive Care Unit (ICU), Qian Jiang Central Hospital of Hubei Province, Qian Jiang Hospital Affiliated to Renmin Hospital of Wuhan University, Qian Jiang Clinical Medical College, Health Science Center, Yangtze University, Qianjiang, China.
Insights
Individuals with inflammatory bowel disease (IBD) face an increased risk of stroke. This meta-analysis confirms this association, highlighting the need for stroke risk assessments in IBD patients, particularly young females.
Area of Science:
- Gastroenterology and Neurology
- Epidemiology
- Cardiovascular Research
Background:
- Previous meta-analyses suggest a link between inflammatory bowel disease (IBD) and stroke risk, but suffered from heterogeneity and methodological limitations.
- This study addresses these limitations by conducting a rigorous meta-analysis to clarify the association between IBD and stroke.
- The research aims to provide a more credible assessment of stroke risk in individuals with IBD.
Approach:
- A comprehensive literature search was performed across PubMed, Embase, and Web of Science databases up to June 30, 2023.
- A random effects model with generic inverse variance was employed for the meta-analysis.
- Publication bias, sensitivity, and subgroup analyses were conducted to ensure robustness and explore heterogeneity.
Key Points:
- The meta-analysis synthesized data from 12 cohort studies, encompassing over 4.4 million individuals.
- Results indicate a statistically significant association between IBD and an increased risk of stroke (RR = 1.19, 95% CI: 1.14-1.24, p < 0.00001).
- The findings remained stable and robust across sensitivity and subgroup analyses.
Conclusions:
- Inflammatory bowel disease is associated with a significantly elevated risk of stroke.
- Proactive stroke risk assessment is recommended for all IBD patients, with a focus on young females and ischemic stroke.
- Further prospective research is needed to investigate stroke subtypes, IBD severity, treatments, and geographical variations.
Background/Objectives:
Recently, four meta-analyses have explored the association between inflammatory bowel disease (IBD) and the risk of stroke. These studies have demonstrated that people with IBD may be at an increased risk of stroke. However, some limitations such as high heterogeneity and the lack of uniformity in the types of research, especially the reuse of some sample sizes, cannot be neglected. These factors reduce the credibility of their research conclusions. Therefore, we conducted a meta-analysis to explore this possible association.
Methods:
PubMed, Embase, and Web of Science were searched from inception to 30 June 2023. A random effects model with the generic inverse variance method was used in this meta-analysis. The Review Manager software was used to obtain all relative risks (RRs) and their 95% confidence intervals (CIs). Publication bias was tested, and sensitivity and subgroup analyses were conducted to explore possible heterogeneities.
Results:
This meta-analysis included 12 cohort studies (involving 4,495,055 individuals). Meta-analysis of these data has shown that IBD was associated with an increased risk of stroke (RR = 1.19, 95%CI:1.14-1.24, p < 0.00001). Our results were stable and robust in subgroup and sensitivity analyses.
Conclusions:
Our results suggest that IBD is associated with an increased risk of stroke. To reduce the incidence of stroke, patients with IBD are encouraged to undergo stroke risk assessments, especially for young female patients; assessing the risk of ischemic stroke is of particular importance. Prospective studies considering stroke subtypes, IBD severity and treatments, regions, and other confounding factors are needed to further explore the nature of each association.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022373656.
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