Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study

TY - JOUR

T1 - Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease

T2 - a nationwide study

AU - Kristensen, Søren Lund

AU - Lindhardsen, Jesper

AU - Ahlehoff, Ole

AU - Erichsen, Rune

AU - Lamberts, Morten

AU - Khalid, Usman

AU - Torp-Pedersen, Christian

AU - Nielsen, Ole Haagen

AU - Gislason, Gunnar Hilmar

AU - Hansen, Peter Riis

PY - 2014/4/1

Y1 - 2014/4/1

N2 - AIMS: Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD.METHODS AND RESULTS: From Danish nationwide registries 1996-2011, we identified 24 499 patients with new-onset IBD and 236 275 age- and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent activity [IRR 2.06 (1.67-2.55)], whereas no increased AF risk was observed in remission periods [IRR 0.97 (0.88-1.08)]. Likewise increased stroke risk was exclusively found during active IBD [IRRs: 1.57 (1.27-1.93), 1.71 (1.32-2.21), and 1.04 (0.93-1.15) for flares, persistent activity, and remission, respectively].CONCLUSION: Active IBD is associated with increased risk of AF and stroke. These findings may be relevant to clinical practice.

AB - AIMS: Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD.METHODS AND RESULTS: From Danish nationwide registries 1996-2011, we identified 24 499 patients with new-onset IBD and 236 275 age- and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent activity [IRR 2.06 (1.67-2.55)], whereas no increased AF risk was observed in remission periods [IRR 0.97 (0.88-1.08)]. Likewise increased stroke risk was exclusively found during active IBD [IRRs: 1.57 (1.27-1.93), 1.71 (1.32-2.21), and 1.04 (0.93-1.15) for flares, persistent activity, and remission, respectively].CONCLUSION: Active IBD is associated with increased risk of AF and stroke. These findings may be relevant to clinical practice.

KW - Adrenal Cortex Hormones

KW - Adult

KW - Atrial Fibrillation

KW - Biological Products

KW - Case-Control Studies

KW - Colitis, Ulcerative

KW - Crohn Disease

KW - Denmark

KW - Disease Progression

KW - Female

KW - Hospitalization

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Registries

KW - Remission Induction

KW - Risk Assessment

KW - Risk Factors

KW - Severity of Illness Index

KW - Stroke

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1093/europace/eut312

DO - 10.1093/europace/eut312

M3 - Journal article

C2 - 24108228

SN - 1099-5129

VL - 16

SP - 477

EP - 484

JO - Europace

JF - Europace

IS - 4

ER -