Small Bowel Vascular Lesions Are Associated with an Increased Risk of Subsequent Cardiovascular Disease After Small
Taiki Aoyama1, Akira Fukumoto2, Gentaro Sindo1
1Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Japan.
Insights
Small-bowel vascular lesions (SBVLs) do not impact overall survival but significantly increase cardiovascular disease (CVD) risk. Detecting SBVLs may indicate systemic vascular vulnerability needing long-term CVD surveillance.
Area of Science:
- Gastroenterology
- Cardiology
- Vascular Medicine
Background:
- Small-bowel vascular lesions (SBVLs) are increasingly identified during investigations for obscure gastrointestinal bleeding.
- The prognostic significance of SBVLs, particularly concerning cardiovascular outcomes, remains incompletely understood.
Purpose of the Study:
- To evaluate the prognostic value of SBVLs by comparing overall survival and cardiovascular disease (CVD) incidence in patients with and without SBVLs after small-bowel bleeding.
- To determine if SBVLs are an independent risk factor for adverse cardiovascular events.
Main Methods:
- Retrospective analysis of 327 patients undergoing capsule endoscopy or double-balloon enteroscopy for suspected small bowel bleeding (Jan 2015-Sep 2023).
- Patients were categorized into SBVL-present (n=95) and SBVL-absent groups, excluding those with liver cirrhosis, Osler-Weber syndrome, or <1 month follow-up.
- Kaplan-Meier and Cox proportional hazards models assessed cumulative survival and CVD incidence over a median 33-month follow-up.
Main Results:
- The SBVL-present group exhibited higher rates of smoking, hypertension, pre-existing CVD, chronic kidney disease, and use of antiplatelet/proton pump inhibitors.
- No significant difference in overall survival was observed between groups (5-year survival: 73% vs. 83%, p=0.17).
- The cumulative incidence of CVD events was markedly higher in the SBVL-present group (5-year incidence: 43% vs. 9%, p<0.01), with SBVL presence independently associated with increased CVD risk (aHR, 3.81).
Conclusions:
- Small-bowel vascular lesions do not negatively impact overall survival in patients with small-bowel bleeding.
- SBVLs are independently associated with a substantially increased risk of subsequent cardiovascular disease events.
- Detection of SBVLs may signal systemic vascular vulnerability, necessitating vigilant long-term cardiovascular monitoring.
Abstract:
Objective We evaluated the prognostic significance of small-bowel vascular lesions (SBVLs) by comparing the overall survival and cardiovascular disease (CVD) incidence in patients with and without SBVLs following small-bowel bleeding. Methods We retrospectively analyzed consecutive patients who underwent capsule endoscopy or double-balloon enteroscopy for suspected small bowel bleeding between January 2015 and September 2023. Patients with liver cirrhosis, Osler-Weber syndrome, or a follow-up period of <1 month were excluded. The patients were categorized into the SBVL-present and SBVL-absent groups. The baseline characteristics were compared, and cumulative survival and CVD incidence were assessed using the Kaplan-Meier method and Cox proportional hazards models. Results The cohort comprised 327 patients (188 men and 139 women; mean age, 71.5 years), of whom 95 (29%) had SBVLs. The SBVL-present group had a higher prevalence of smoking, hypertension, preexisting CVD, chronic kidney disease, and antiplatelet and proton pump inhibitor use. Over a median follow-up of 33 months, cumulative survival did not differ significantly between the groups (5-year survival: 73% vs. 83%, p=0.17), and no deaths were attributable to gastrointestinal bleeding. In contrast, the cumulative CVD incidence was significantly higher in the SBVL-present group (5-year incidence: 43% vs. 9%, p<0.01). The presence of SBVL was independently associated with an increased risk of CVD events (adjusted hazard ratio, 3.81; 95% confidence interval, 1.86-7.78). Conclusion SBVLs do not adversely affect overall survival, but are independently associated with a substantially increased risk of subsequent CVD events. Therefore, the detection of SBVLs may serve as a marker of systemic vascular vulnerability, warranting careful long-term cardiovascular surveillance.
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