Patients With Inflammatory Bowel Disease Have an Increased Risk of Myocardial Infarction

A Nationwide Study

Yoon Jin Choi; Dong Ho Lee; Dong Woo Shin; Kyung-Do Han; Hyuk Yoon; Cheol Min Shin; Young Soo Park; Nayoung Kim

Disclosures

Aliment Pharmacol Ther. 2019;50(7):769-779. 

In This Article

Abstract and Introduction

Abstract

Background: Inflammatory bowel disease (IBD) is accompanied by various extraintestinal manifestations including systemic inflammation and hypercoagulability, which may increase the risk of atherosclerosis and ischaemic heart disease.

Aim: To investigate whether IBD is associated with an increased risk of myocardial infarction (MI), stroke or death

Methods: The International Classification of Disease, 10th edition codes and the claim codes for rare diseases were used to identify candidates from National Health Insurance Service (NHIS) of South Korea. Patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 2006 and 2009 were age-matched 1:3 with NHIS enrolees without IBD. The primary outcomes included newly developed MI, stroke and death. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models.

Results: We identified 10 708 patients diagnosed with CD and 26 769 with UC. MI risk was higher in CD patients than in controls (incidence ratio (IR) 1.64 per 1000 person-years, HR, 1.80; 95% CI, 1.47-2.21), and this trend was more prominent among patients aged <40 years (IR 0.69 per 1000 person-years, HR, 2.96; 95% CI, 1.96-4.47) and among female patients (IR 2.35 per 1000 person-years, HR, 2.18; 95% CI, 1.61-2.94). In contrast, only female patients with UC had an increased risk of MI (IR 2.01 per 1000 person-years, HR, 1.33; 95% CI, 1.13-1.56).

Conclusions: The risk of MI risk is higher in patients with CD than in the general population, and this trend is stronger in female patients and those aged <40 years.

Introduction

The inflammatory bowel diseases (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) are the chronic, relapsing inflammatory condition that affects gastrointestinal tracts. The aetiology and pathophysiology of IBD remain unclear; hence, lifelong management for the condition is required.

The peak age of onset is generally 20–30 years for CD and 30–40 years for UC.[1] Because CD and UC frequently occur in young adults and have a remitting and relapsing course, the socioeconomic burden of such conditions is enormous.

While IBD has traditionally been regarded as a disease of westernised countries, in the past 20 years, its prevalence has increased even in Asian countries; thus, IBD is currently a global disease.[2] The most recent report indicates that South Korea has the highest IBD incidence in East Asia, with an average annual incidence of 0.5 per million for UC and 0.28 per million for CD.[3]

According to data the National Statistical Office reported, the second and third common cause of death in South Korea is cardiovascular diseases (CVDs) and cerebrovascular diseases, which accounts for 22.0% of all deaths in 2010.[4] The burden of these CVDs in South Korea was considered to be only slightly lower than that in Western Europe.[5]

Inflammation plays an important role in coronary heart disease by triggering atherosclerosis-related processes, from plaque formation to thrombus rupture.[6] While IBD is an established risk factor for venous thromboembolism,[7] its potential association with the development of coronary heart disease and stroke has been highlighted only recently. Some studies have reported that IBD may be associated with increased risk of CVD, but this association remains controversial.[7–11] The reason for these inconclusive results might be related with the heterogeneity of IBD patient cohorts studied to date; such heterogeneity is apparent in terms of age, sex, ethnicity and disease activity. Most studies have been performed in Western countries.[10]

Therefore, we performed a nationwide cohort study aiming to evaluate the risk of myocardial infarction (MI), stroke and mortality in IBD patients vs the general population, as well as to assess the impact of age, sex and disease activity on the risk of acute arterial events in individuals of South Korea.

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