Risk of ischaemic heart disease in patients with inflammatory bowel disease: a nationwide Danish cohort study

TY - JOUR

T1 - Risk of ischaemic heart disease in patients with inflammatory bowel disease

T2 - a nationwide Danish cohort study

AU - Rungoe, Christine

AU - Basit, Saima

AU - Ranthe, Mattis Flyvholm

AU - Wohlfahrt, Jan

AU - Langholz, Ebbe

AU - Jess, Tine

PY - 2013/5

Y1 - 2013/5

N2 - Background Inflammatory bowel disease (IBD) is a chronic inflammatory disorder. Systemic inflammation increases the risk of atherosclerosis and ischaemic heart disease (IHD). Objective To examine the impact of IBD, including its duration and treatment, on the risk of IHD. Methods In a nationwide population-based cohort of 4.6 million Danes aged =15 years, we compared people diagnosed with IBD during 1997-2009 (n=28 833) with IBD-free individuals. Subjects with IHD were identified in the National Patient Register. Using Poisson regression, we estimated the incidence rate ratios (IRRs) for IHD with 95% CI with adjustment for age, gender, socioeconomic status, calendar year and use of drugs for comorbidities. Results A markedly increased risk of IHD was seen within the first year after IBD diagnosis (IRR=2.13 95% CI 1.91 to 2.38). During 1-13 years of follow-up after IBD diagnosis, the risk of IHD was 1.22 (95% CI 1.14 to 1.30). The risk of IHD was lower among patients with IBD using 5-aminosalicylic acids (IRR=1.16; 95% CI 1.06 to 1.26) than among non-users (IRR=1.36; 95% CI 1.22 to 1.51) ( p=0.02), in particular among oral corticosteroid users, used as a proxy for disease severity. Likewise patients treated surgically or with thiopurines and tumour necrosis factor a antagonists tended to have reduced IRRs for IHD. Conclusions The risk of IHD was highest in the first year after IBD diagnosis, possibly owing to ascertainment bias. The increased long-term risk of IHD in IBD may be related to chronic inflammation, and interventions reducing the inflammatory burden may attenuate this risk.

AB - Background Inflammatory bowel disease (IBD) is a chronic inflammatory disorder. Systemic inflammation increases the risk of atherosclerosis and ischaemic heart disease (IHD). Objective To examine the impact of IBD, including its duration and treatment, on the risk of IHD. Methods In a nationwide population-based cohort of 4.6 million Danes aged =15 years, we compared people diagnosed with IBD during 1997-2009 (n=28 833) with IBD-free individuals. Subjects with IHD were identified in the National Patient Register. Using Poisson regression, we estimated the incidence rate ratios (IRRs) for IHD with 95% CI with adjustment for age, gender, socioeconomic status, calendar year and use of drugs for comorbidities. Results A markedly increased risk of IHD was seen within the first year after IBD diagnosis (IRR=2.13 95% CI 1.91 to 2.38). During 1-13 years of follow-up after IBD diagnosis, the risk of IHD was 1.22 (95% CI 1.14 to 1.30). The risk of IHD was lower among patients with IBD using 5-aminosalicylic acids (IRR=1.16; 95% CI 1.06 to 1.26) than among non-users (IRR=1.36; 95% CI 1.22 to 1.51) ( p=0.02), in particular among oral corticosteroid users, used as a proxy for disease severity. Likewise patients treated surgically or with thiopurines and tumour necrosis factor a antagonists tended to have reduced IRRs for IHD. Conclusions The risk of IHD was highest in the first year after IBD diagnosis, possibly owing to ascertainment bias. The increased long-term risk of IHD in IBD may be related to chronic inflammation, and interventions reducing the inflammatory burden may attenuate this risk.

KW - Adolescent

KW - Adult

KW - Aged

KW - Atherosclerosis/epidemiology

KW - Case-Control Studies

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Immunosuppressive Agents/therapeutic use

KW - Incidence

KW - Inflammatory Bowel Diseases/complications

KW - Male

KW - Mercaptopurine/therapeutic use

KW - Mesalamine/therapeutic use

KW - Middle Aged

KW - Myocardial Ischemia/epidemiology

KW - Registries

KW - Risk

KW - Severity of Illness Index

KW - Tumor Necrosis Factor-alpha/antagonists & inhibitors

U2 - 10.1136/gutjnl-2012-303285

DO - 10.1136/gutjnl-2012-303285

M3 - Journal article

C2 - 22961677

SN - 0017-5749

VL - 62

SP - 689

EP - 694

JO - Gut

JF - Gut

IS - 5

ER -