Inflammatory Bowel Disease Tied to MI Risk

By Lisa Rapaport

December 17, 2018

(Reuters Health) - People with inflammatory bowel disease may be up to 12 times more likely to suffer myocardial infarction (MI), a U.S. study suggests.

Inflammatory bowel disease (IBD) involves chronic or recurring inflammation of the gastrointestinal tract

While chronic inflammation has long been linked to an increased risk of cardiovascular disease, the potential for conditions like Crohn's disease and ulcerative colitis to lead to MI isn't as well understood, the study team notes in a paper in the journal Inflammatory Bowel Diseases, November 30.

The researchers examined a nationwide database of medical records for more than 29 million people, including almost 132,000 with ulcerative colitis and 159,000 with Crohn's disease.

Over the five-year study period, people with IBD were 25 percent more likely than those without the disorder to suffer MI, the study found.

"IBD should be regarded as an independent risk factor for the development of heart disease," said senior author Dr. Mahazarin Ginwalla of University Hospitals Cleveland Medical Center in Ohio.

This means people with IBD should be monitored carefully for cardiac risk factors like smoking, obesity, hypertension, diabetes and high cholesterol, Ginwalla said by email. Treating risk factors, and keeping symptoms of IBD controlled, may lower the risk of heart attacks, Ginwalla said.

For people with IBD, "the risk of adverse cardiovascular events is highest during active flares or persistent disease, with this risk diminishing during times of remission," Ginwalla added.

During the study, 3.3 percent of people without IBD had a heart attack, compared to 6.7 percent of patients with ulcerative colitis and 8.8 percent of individuals with Crohn's disease.

The biggest increased risk of MI for people with IBD was seen among younger people.

IBD patients ages 30 to 34 were 12 times more likely to have a heart attack than people in their age group without IBD, the study found.

By age 65, however, people with IBD were only about twice as likely to have MI as people without these conditions.

It's possible that chronic inflammation in people with IBD might lead to clotting in the blood and more clots in the arteries, which then leads to MI, said Dr. Miguel Regueiro of Cleveland Clinic in Ohio.

"The IBD is probably indirectly causing the heart attack from the body's response to inflammation," Regueiro, who wasn't involved in the study, said by email.

The results add to growing evidence that patients with IBD may be at increased risk for heart attacks, said Dr. Gilaad Kaplan of the University of Calgary in Canada.

"With this knowledge, it is important that patients with IBD minimize their future risk by talking to their primary care doctor about risk factor modifications," Kaplan, who wasn't involved in the study, said by email. This includes a healthy diet, smoking cessation, controlling blood pressure and cholesterol, and managing diabetes, Kaplan advised.


Inflamm Bowel Dis 2018.