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Risk factors associated with Gastrointestinal Bleeding in Patients with Cardiovascular Disease (INTERBLEED): a case
Jacqueline Bosch1,2, Martin O'Donnell3, Qilong Yi1
1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Insights
This study identified key risk factors for gastrointestinal bleeding in cardiovascular disease patients. Many of these risk factors are potentially modifiable, offering opportunities for prevention.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Epidemiology
Background:
- Gastrointestinal (GI) bleeding is a significant concern in patients with cardiovascular disease (CVD).
- Identifying and quantifying risk factors is crucial for effective prevention and management strategies.
Purpose of the Study:
- To identify and quantify the importance of risk factors for GI bleeding in patients with CVD.
- To determine the proportion of GI bleeding attributable to potentially modifiable risk factors.
Main Methods:
- A case-control study was conducted across 9 countries in Asia, America, Europe, and Australia.
- Cases included patients with CVD and GI bleeding; controls had CVD without a history of GI bleeding.
- Adjusted odds ratios (ORs) and average population attributable fractions (aPAFs) were calculated to assess risk factor importance.
Main Results:
- Key independent risk factors identified include advanced age, underweight status, current smoking, chronic kidney disease, prior stroke, glucocorticoid use, NSAIDs/COX-2 inhibitors, liver disease, peptic ulcer disease, and diverticular disease.
- Antithrombotic therapy within 6 months was also a significant factor.
- The overall average population attributable fraction for GI bleeding was 37.3%, with potentially modifiable factors accounting for approximately one-third of this.
Conclusions:
- Several independent risk factors contribute significantly to GI bleeding in CVD patients.
- A substantial portion of GI bleeding risk is linked to potentially modifiable factors, highlighting targets for intervention.
Aims:
This study aimed to identify and quantify the importance of risk factors for gastrointestinal (GI) bleeding in patients with CV disease.
Methods:
We conducted a case-control study in 9 countries in Asia, America, Europe, and Australia. Cases were patients with CV disease with GI bleeding. Controls were patients with CV without a history of GI bleeding. All participants completed a baseline standardized assessment. We calculated adjusted odds ratios (ORs) and average population attributable fractions (aPAFs) with 95% confidence intervals (CIs).
Results:
Between September 2015 and December 2022, we enrolled 2,519 cases and 2,202 controls. Independent risk factors for GI bleeding were age (age 71+: OR 4.16, 95% CI 3.48-4.97; age 61-70: OR 1.69, 95% CI 1.39-2.04; age ≤60 as reference), underweight (OR 3.38, 95% CI 2.24-5.10; aPAF 1.6%, 95% CI 1.0-2.0%), current smoker (OR 1.31; 95% CI 1.09-1.58; aPAF 1.5%, 95% CI 0.6-2.5); chronic kidney disease (OR 1.86, 95% CI 1.62-2.14; aPAF 8.8%, 95% CI 7.0-9.6%), prior stroke (OR 1.56, 95% CI 1.30-1.88, aPAF 2.6%, 95% CI 1.2-4.0%), glucocorticoids (OR 1.71, 95% CI 1.34-2.16, aPAF 1.8%, 95% CI 1.3-2.9%), NSAIDs or COX-2 inhibitors (OR 1.82, 95% CI 1.45-2.29; aPAF 2.2%, 95% CI 1.3-3.0%), liver disease (OR 3.68, 95% CI 2.77-4.89; aPAF 3.5%, 95% CI 2.8-4.2%), peptic ulcer disease (OR 3.38, 95% CI 2.66-4.31; aPAF 4.8%, 95% CI 3.8-5.7%), diverticular disease (OR 1.81, 95% CI 1.46-2.24; aPAF 2.8%, 1.9-3.6%) and antithrombotic therapy within 6 months (aPAF 7.6%, 95% CI 4.3-12.8%). Overall aPAF adjusted for age, sex and region was 37.3% (95% CI 33.0-42.2%).
Conclusion:
Potentially modifiable risk factors are associated with only about one third of the aPAF for GI bleeding.
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