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Risk of Adverse Cardiovascular Outcomes in Postmenopausal Women with Inflammatory Bowel Disease
Ruby Greywoode1, Joseph Larson2, Jellyana Peraza3
1Division of Gastroenterology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY, 10467, USA. rgreywoode@montefiore.org.
Insights
Women with inflammatory bowel disease (IBD) may face a higher risk of ischemic stroke post-menopause. Further research is needed to confirm this association and understand its implications for cardiovascular disease (CVD) prevention in this population.
Area of Science:
- Cardiovascular Health
- Gastroenterology
- Women's Health
Background:
- Individuals with inflammatory bowel disease (IBD) often present with adverse cardiovascular disease (CVD) outcomes, even without traditional risk factors.
- The CVD risk in postmenopausal women with IBD remains largely unexamined.
Purpose of the Study:
- To investigate the association between IBD and CVD risk in postmenopausal women.
- To determine if women with IBD have an increased risk of specific cardiovascular events after menopause.
Main Methods:
- Survival analysis was performed on Women's Health Initiative (WHI) participants.
- Cox proportional hazard models were used to assess the risk of coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), and peripheral arterial disease (PAD) between women with and without IBD.
- Models were adjusted for numerous demographic, comorbidity, and lifestyle factors.
Main Results:
- The study included 134,022 participants, with 1.0% reporting IBD.
- No significant differences in CHD, VTE, or PAD risk were found between IBD and non-IBD women.
- A statistically significant higher risk of ischemic stroke was initially observed in IBD women, but this attenuated with further adjustment.
Conclusions:
- Postmenopausal women with IBD may have an elevated risk of ischemic stroke.
- The findings suggest a potential link between IBD and cerebrovascular risk in postmenopausal women, warranting further investigation.
Background:
Individuals with inflammatory bowel disease (IBD) who lack traditional cardiovascular disease (CVD) risk factors, such as young females, are observed to experience adverse CVD outcomes. Whether women with IBD have increased CVD risk after the menopause transition is unclear.
Methods:
We conducted a survival analysis of Women's Health Initiative (WHI) participants and excluded those with missing IBD diagnosis, model covariate data, follow-up data, or a baseline history of the following CVD outcomes: coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), peripheral arterial disease (PAD). Risk of outcomes between IBD and non-IBD women was performed using Cox proportional hazard models, stratified by WHI trial and follow-up. Models were adjusted for age, socio-demographics, comorbidities (e.g., hypertension, diabetes, hypercholesterolemia, etc.), family history, and lifestyle factors (e.g., smoking, alcohol, physical activity, body mass index, etc.).
Results:
Of 134,022 WHI participants meeting inclusion criteria, 1367 (1.0%) reported IBD at baseline. Mean baseline age was 63.4 years. After adjusting for age and other confounders, no significant difference was observed between IBD and non-IBD women for the risk of CHD (HR 0.96, 95% CI 0.73-1.24), VTE (HR 1.11, 95% CI 0.81-1.52) or PAD (HR 0.64, 95% CI 0.28-1.42). After adjusting for age, risk of ischemic stroke was significantly higher (HR 1.41, 95% CI 1.06-1.88) in IBD than non-IBD women. With further adjustment, the excess risk of ischemic stroke among IBD women was attenuated and no longer statistically significant (HR 1.31, 95% CI 0.98-1.76).
Conclusions:
Among postmenopausal women with IBD, risk of ischemic stroke may be higher than in non-IBD women.
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