Crohn's, Colitis Increase Risk for Acute Arterial Events

Neil Osterweil

February 17, 2017

BARCELONA — Patients with severe inflammatory bowel disease (IBD) are at higher risk for acute arterial events than people in the general population, and young patients with Crohn's disease appear to be at the highest relative risk, according to a large cohort study.

A high level of Crohn's disease or ulcerative colitis activity 3 months before and after an IBD-related hospitalization was associated with a nearly twofold risk for a first acute arterial event, such as ischemic heart disease, cerebrovascular disease, or peripheral artery disease, said Julien Kirchgesner, MD, a gastroenterologist at Hôpital Saint-Antoine in Paris.

"Our findings are in accordance with the hypothesis that tight control of inflammation could prevent IBD-related systemic complications," he said here at the European Crohn's and Colitis Organisation 2017 Congress.

Whether treatment, including anti-tumor necrosis factor-alpha agents, has any effect on the association between IBD and arterial disease is still unclear, he added.

Chronic systemic inflammation is a known risk factor for acute arterial events, but whether IBD is also associated with risk for ischemic heart disease, stroke, or other events remains to be determined, said Dr Kirchgesner.

To get a better handle on these risks, he and his colleagues conducted a retrospective review of French hospital discharge data from 2008 to 2013, which covered the entire French population. They identified 210,162 patients 15 years and older with a diagnosis of IBD — 97,708 with Crohn's disease and 112,454 with ulcerative colitis.

The investigators looked at acute arterial events, cardiovascular risk factors, surgical procedures, and hospitalizations. They compared the incidence of a first acute arterial event in patients with IBD with the expected incidence in the general French population matched for geographic region, sex, and 5-year age-specific stratum.

Table 1. Acute Arterial Events During 595,202 Person-Years of Follow-up

Patient Group Events (n) Incidence Rate (per 1000 Person-Years)
IBD 5554 9.3
Crohn's disease 2244 7.8
Ulcerative colitis 3310 10.7

 

When patients were compared with the general population, the incidence of all acute arterial events was higher in the patients.

For all IBD patients, the standardized incidence ratio (SIR) for ischemic heart disease was 1.17 (P < .001), for cerebrovascular disease it was 1.19 (P < .001), and for peripheral artery disease it was 1.27 (P < .001).

When patients with Crohn's disease were compared with the general population, the risk for an event was highest in those younger than 55 years (SIR, 1.56), followed by those 55 to 74 years (SIR, 1.38), and those 75 years and older (SIR, 1.13). However, when patients with ulcerative colitis were compared with the general population, the risk for an event was only higher in those 55 to 74 years (SIR, 1.15).

Table 2. Incidence of All Acute Arterial Events

IBD 1.19 <.001
Crohn's disease 1.35 <.001
Ulcerative colitis 1.10 <.001

 

On multivariate analysis, adjusted for age at cohort entry, sex, region, year of cohort entry, disease activity prior to cohort entry, and known cardiovascular risk factors, factors predictive of acute arterial events included being male, smoking, and having hypertension, dyslipidemia, diabetes, or alcohol use disorder.

There was a significant association between disease activity in the 3 months before and after an IBD hospitalization and the risk for an arterial event in those with Crohn's disease (hazard ratio [HR], 1.74) and in those with ulcerative colitis (HR, 1.87).

The Kid Next Door

These findings are particularly interesting, said session comoderator Stefan Vavricka, MD, a gastroenterologist at Stadtspital Triemli in Zurich.

"As a child, I had a neighbor who had Crohn's disease, who all of a sudden, without having any cardiovascular risk factors, developed arterial disease and had to have his left foot amputated. I always wondered why that happened. This gives me a better understanding," he told Medscape Medical News.

"There are other studies to confirm that there is an association between IBD and cardiovascular disease, and also ischemic heart disease," said session comoderator and study coauthor Nynne Nyboe Andersen, MD, a gastroenterology researcher at the Statens Serum Institut in Copenhagen, Denmark.

"The challenge now is how to implement screening for this in a clinical setting. We don't want to worry patients, but we need to find out what impact this will have in a clinical setting," she told Medscape Medical News.

The study was funded by the French National Institute for Health and Medical Research (INSERM). Dr Kirchgesner, Dr Vavricka, and Dr Andersen have disclosed no relevant financial relationships.

European Crohn's and Colitis Organisation (ECCO) 2017 Congress: Abstract OP003. Presented February 16, 2017.

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