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Association of diverticulitis and potential risk of ischemic stroke: population-based matched cohort study in Taiwan
Kuan Chen1, Yung-Chang Wang2,3, Kuang-Tsu Yang4
1Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
Insights
Colon diverticulitis increases the risk of ischemic stroke (IS). This association is particularly strong in younger adults aged 30-39 years, highlighting a need for preventative measures.
Area of Science:
- Gastroenterology
- Neurology
- Epidemiology
Background:
- Diverticular disease is linked to cardiovascular disease.
- Shared pathogenesis between cardiovascular disease and cerebrovascular accident suggests diverticulitis as a potential stroke risk factor.
Purpose of the Study:
- To establish epidemiological evidence for the relationship between colon diverticulitis and ischemic stroke.
- Investigate colon diverticulitis as a risk factor for ischemic stroke.
Main Methods:
- Retrospective cohort study comparing 6,238 patients with colon diverticulitis to 24,952 controls.
- Propensity score matching (1:4 ratio) for age, sex, comorbidities, and medications.
- Cox proportional hazard regression analysis to determine the hazard ratio for ischemic stroke.
Main Results:
- Patients with diverticulitis showed a significantly higher risk of ischemic stroke (adjusted HR, 1.25; 95% CI, 1.12-1.39).
- Sensitivity analyses confirmed a consistent positive association between diverticulitis and ischemic stroke.
- A 2.54-fold higher risk of ischemic stroke was observed in the diverticulitis group aged 30-39 years.
Conclusions:
- Colon diverticulitis is associated with an increased risk of subsequent ischemic stroke.
- The risk is notably higher in younger individuals (30-39 years) within the Asian population.
- Findings suggest opportunities for preventive strategies targeting high-risk patients.
Background:
Previous studies have suggested relationship between diverticular disease and cardiovascular disease. Since cardiovascular disease and cerebrovascular accident share a lot of pathogenesis, diverticulitis could also be a risk factor for stroke. This study tried to establish epidemiological evidence of the relationship between colon diverticulitis and ischemic stroke.
Methods:
In this retrospective cohort study, patients with newly diagnosed colon diverticulitis (N = 6238) and patients without colon diverticulitis (control group; N = 24 952) were recruited between January 1, 2000, and December 31, 2017. Both groups were matched by propensity score at a 1:4 ratio by age, sex, comorbidities and medications. Cox proportional hazard regression was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) of ischemic stroke. We also conducted 4 different regression models and 2 sensitivity analyses to test the robustness of our findings.
Results:
The diverticulitis group had a higher risk of IS than the control group (adjusted HR, 1.25; 95% CI, 1.12-1.39; P < 0.001). Serial sensitivity analyses yielded consistent positive link between diverticulitis and IS. Further subgroup analysis showed that in the study group, the risk of IS was 2.54-fold higher than the matched controls in 30-39 years.
Conclusions:
Our study found that colon diverticulitis was associated with a higher risk of developing subsequent ischemic stroke, especially for patients aged 30-39 years, among Asian population. This result provides us a chance to undertake preventive measures for ischemic stroke in high-risk patients.
