People With IBD Have Increased Risk for Myocardial Infarction, Stroke

Patients with inflammatory bowel disease (IBD) may be at increased risk for myocardial infarction (MI), according to results of a systematic review and meta-analysis published in the International Journal of Cardiology.

Researchers searched publication databases for studies of IBD and cardiovascular disease. The primary endpoint was MI, and secondary endpoints were all-cause mortality and stroke.

A total of 8 studies comprising 77,140 cases of IBD and 515,455 control individuals were included in the analysis. Among the IBD group, 62.5% had ulcerative colitis (UC) and 34.8% Crohn disease (CD). The cases and control individuals were well balanced for age, but the patients with CD and UC had lower rates of hypertension (14.5% and 14.6% vs 25%), diabetes (2.9% and 5.2% vs 9.2%), and dyslipidemia (3.3% and 6.5% vs 16.1%) compared with control individuals, respectively.

During a 5.2-year follow-up, MI occurred among 1.57% of control individuals, 2.33% of patients with UC, and 2.35% of patients with CD; all-cause mortality among 2.50%, 4.63%, and 3.66%; and stroke among 1.49%, 1.61%, and 2.26%, respectively.

In the adjusted analyses, CD was associated with increased risk for MI (hazard ratio [HR], 1.36; 95% CI, 1.12-1.64), all-cause mortality (HR, 1.55; 95% CI, 1.27-1.90), and stroke (HR, 1.22; 95% CI, 1.01-1.49) and UC was similarly associated with higher risk for MI (HR, 1.24; 95% CI, 1.05-1.46), all-cause mortality (HR, 1.29; 95% CI, 1.01-1.64), and stroke (HR, 1.09; 95% CI, 1.03-1.15) compared with control individuals.

In a mediation analysis, the effect of UC on MI was reduced by age (b, -0.0577; P =.01), diabetes (b, -0.0355; P =.0185), and hyperlipidemia (b, -0.0135; P =.0388) and in part by smoking (b, -0.015; P =.0648).

These findings may have been biased, as some studies defined MI as only those events requiring hospitalization.

Analysis authors concluded, “Our study seems to support a greater risk of arterial ischemic events (particularly MI) in persons with IBD (in the whole group and in both CD and UC) compared to the general population, despite a lower prevalence of the classic risk factors for MI (hypertension, diabetes, dyslipidemia). This could be related to the presence of nonconventional risk factors for MI (particularly inflammation) that play a key role in IBD patients.”