Microscopic colitis and MACE

Microscopic colitis and MACE

August 15, 2023

Issue 15

Clinical Question

What is the risk of major adverse cardiovascular events with microscopic colitis?

Editor’s Bottom Line

Microscopic colitis is associated with an increased risk of major adverse cardiovascular events, and its diagnosis could provide an opportunity to address reversible risk factors.


Forss A, Bergman D, Roelstraete B, et al. Patients With Microscopic Colitis Are at Higher Risk of Major Adverse Cardiovascular Events: A Matched Cohort Study. Clin Gastroenterol Hepatol. Epub ahead of print May 26, 2023; https://linkinghub.elsevier.com


This study analyzed the risk of major adverse cardiovascular events (MACE), including ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality, among individuals with microscopic colitis. It included data from 11,018 adults with microscopic colitis treated in Sweden between 1990 and 2017 who were a median 60 years of age at the start of follow-up. None of the participants had known cardiovascular disease prior to the study period and 75% were female.

The study included a cohort of 48,371 controls without microscopic colitis or cardiovascular disease matched by age, sex, year and location. Multivariable analyses adjusted for a number of potential confounders, including medication use and comorbidities, including diabetes, obesity, hypertension and dyslipidemia. All of these, along with chronic kidney disease and celiac disease, were significantly more common among those with microscopic colitis.

After a median 6.6 years of follow-up, 19.8% of those with microscopic colitis and 13.8% of controls experienced a MACE. Multivariate analyses confirmed the higher risk of MACE outcomes, showing a 27% increased risk of MACE during the study period (adjusted hazard ratio [aHR]: 1.27; 95% Confidence Interval [CI], 1.21–1.33).

The risk of specific cardiovascular events was significantly increased by 38% for ischemic heart disease (aHR, 1.38; 95% CI, 1.28–1.48), 32% for congestive heart failure (aHR, 1.32; 95% CI, 1.22–1.43), and 12% for stroke (aHR, 1.12; 95% CI, 1.02–1.23). The risk of cardiovascular-related death was not increased among those with microscopic colitis.

In a comparison of MACE outcomes among siblings of those with microscopic colitis, researchers found the risk of MACE was still increased by the presence of microscopic colitis, suggesting the risk was not accounted for by genetic and early-life environmental effects.

The authors noted their study may have failed to account for some confounding variables, including body mass index, alcohol consumption, diet, smoking and lipid profiles.


Study Design: Nationwide, population-based match cohort

Funding: The Bengt Ihre Foundation and the Swedish Society of Medicine

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 1b