Ulcerative Colitis, Crohn's Flares May Raise Post-MI Risk: Registry Study

October 17, 2014

COPENHAGEN, DENMARK — Patients with inflammatory bowel disease (IBD) who are discharged after hospitalization for a first acute MI have elevated risks of death and cardiovascular events, especially if they have a flare-up of their IBD, suggests a nationwide registry study[1]. Flares were also associated with worse 30-day mortality. Patients with IBD that had been and remained in remission showed post-MI risk similar to patients without IBD over the follow-up of about 4 years, reported Dr Søren Lund Kristensen (Copenhagen University Hospital Gentofte, Hellerup, Denmark) and associates October 14, 2014 in Circulation: Cardiovascular Quality and Outcomes.

The findings "suggest that heightened inflammation due to IBD may exert detrimental effects on the cardiovascular system," Kristensen said to heartwire in an email. "This is in line with accumulating evidence that systemic inflammation is a risk factor for cardiovascular disease. Indeed, the cardiovascular system is likely to be more vulnerable to the damaging effects of other sources of inflammation in the period immediately after a myocardial infarction, and this may have contributed to our findings."

The group looked at 86 790 patients in Denmark with first-time MI from 2002 through 2011 and singled out 1030 with ulcerative colitis or Crohn's disease that was either in remission (no disease activity for 120 days), was persistent (activity for at least the prior 120 days), or flared up (disease activity within the past 120 days after at least 120 days of no disease activity).

The rates of death from hospital admission to 30 days postdischarge were 16.2% for those with IBD and 15.4% for those without IBD. The odds ratios (OR) (95% CI, adjusted for age, sex, year of hospitalization, socioeconomic status, comorbidities, and cardiovascular drug therapy) were:

  • 3.29 (1.98–5.45) for those hospitalized with IBD flare-ups.

  • 1.62 (0.95–2.77) for those who had persistent IBD activity.

  • 0.97 (0.78–1.19) for those who had been in remission.

The 73 451 patients who survived to at least 30 days after discharge included 863 (about 1.2%) with IBD. The latter group's IBD status was continuously updated, such that 368 (about 42%) IBD patients remained in remission during a follow-up that averaged 3.9 years. Compared with those without IBD at MI hospitalization, those with any form of the disease during follow-up showed significant 14% and 17% increases in all-cause mortality and cardiovascular events, respectively.

The risks of those two events and especially of recurrent MI climbed the highest for those with an IBD flare before, during, or after the index hospitalization. Hazard ratios were adjusted as before with further adjustment for having PCI or CABG.

Hazard Ratios (95% CI) vs No IBD for Subsequent Outcomes by IBD Status

End Points for >30-d Survivors Any IBD Persistent IBD Activity IBD Flare-up
All-cause mortality 1.14 (1.01–1.28) 2.04 (1.53–2.73) 2.25 (1.61–3.15)
Recurrent MI 1.21 (0.99–1.49) 1.98 (1.09–3.61) 3.09 (1.79–5.32)
CV events* 1.17 (1.03–1.34) 1.73 (1.19-–2.50) 2.04 (1.35–3.06)

*Reinfarction, cardiovascular death, or stroke >30 days from primary discharge

The findings by IBD status didn't vary by drugs received after discharge from the primary hospitalization, according to the group.

"No previous studies of post-MI prognosis in patients with IBD have been reported, but the association between IBD and worsened prognosis after MI is in line with findings in other chronic inflammatory diseases, including rheumatoid arthritis and psoriasis," according to the authors.

Kristensen said that "increased clinical vigilance is warranted toward both cardiovascular and gastrointestinal symptoms in the period following a myocardial infarction for patients with IBD. However, whether improved cardiovascular treatment or more aggressive anti-inflammatory IBD therapy can lower this excess risk requires further studies."

Kristensen had no conflicts of interest. Disclosures for the coauthors are listed in the report.

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