CVD link to IBD diagnosis

October 31, 2023

Issue 21

Clinical Question

Is cardiovascular disease associated with future diagnosis of IBD?

Editor’s Bottom Line

A history of cardiovascular disease is associated with an increased risk of incident IBD. More work is needed to understand the mechanism underlying this association.

Reference

Faye AS, Axelrad JE, Sun J, et al. Atherosclerosis as a Risk Factor of Inflammatory Bowel Disease: A Population-Based Case-Control Study. Am J Gastroenterol. 2023 Oct 9.
Online ahead of print

Synopsis

Prior research has identified a complex link between atherosclerosis and IBD: IBD patients have a higher risk of later ischemic heart disease; there is an overlapping pathophysiology of plaque  deposition activating the innate and adaptive immune systems; and there is a possibility that statins  prevent IBD.

In the current study, researchers in Sweden and the United States set out to examine the likelihood of an atherosclerosis-related event prior to IBD diagnosis. To that end, they analyzed data from a Swedish national patient registry and a separate Swedish histopathology registry between 2002 and 2021. They identified 56,212 adults diagnosed with IBD during that time and documented their risk of an atherosclerotic-related condition—defined as myocardial infarction, thromboembolic stroke or atherosclerosis—prior to their IBD diagnosis. The study also included a matched control cohort of 531,014 individuals without IBD in the general Swedish population.

The analysis revealed that 4.2% of those with IBD and 3.4% of controls had an atherosclerotic-related condition diagnosed prior to their IBD diagnosis, representing a 30% increased risk (Odds Ratio [OR]: 1.30; 95% Confidence Interval [CI], 1.24–1.37). While all three types of atherosclerotic-related conditions were more common among IBD patients, they were at greatest risk of atherosclerosis itself (OR: 1.52; 95% CI, 1.36–1.70).

The risk of an atherosclerotic-related condition was significant for both Crohn’s disease and ulcerative colitis (OR: 1.37; 95% CI, 1.26–1.48 and OR: 1.27; 95% CI, 1.20–1.35, respectively) and persisted for IBD patients as a whole after adjusting for underlying comorbidities (OR: 1.18; 95% CI, 1.13–1.24), prior exposure to aspirin and/or statins (OR: 1.13; 95% CI, 1.06–1.19) or lack of prior exposure to these drugs (OR: 1.34; 95% CI, 1.10–1.64).

Demographically, the risk of an atherosclerotic-related condition prior to IBD diagnosis was highest among those diagnosed with IBD between 40–59 years of age (OR: 1.52; 95% CI, 1.36–1.7) and among females (OR: 1.41; 95% CI, 1.31–1.52).

The highest odds of an atherosclerotic-related condition were seen in the 6–12 months prior to diagnosis of IBD (OR: 1.78; 95% CI, 1.58–2.02), but the risk of atherosclerotic-related condition was increased up to five or more years prior to IBD diagnosis (OR: 1.2; 95% CI, 1.13–1.27).

While IBD patients were at greater risk of having one or more atherosclerosis-related conditions compared to the general population, they were at the highest risk of having more than one such condition (For 1 condition: OR: 1.22; 95% CI, 1.14–1.3; for 2 conditions: OR: 1.31; 95% CI, 1.20–1.44; for 3 conditions: OR: 1.32; 95% CI, 1.21–1.44).

Details

Study Design: Nationwide case-control analysis
Funding: None reported.
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b