Inflammatory Bowel Disease May Up the Risk of MI, Especially in Young People

Having inflammatory bowel disease (IBD) raises the risk of MI independent of traditional cardiovascular risk factors, a new study shows. The risk was highest for the youngest IBD patients and was greater for women than men.

Lead study author Muhammad S. Panhwar, MD (Case Western Reserve University/University Hospitals Cleveland Medical Center, Ohio), said while a relationship between cardiovascular disease and chronic inflammatory conditions such as rheumatoid arthritis, lupus, and psoriasis has been clearly demonstrated, a connection with inflammatory bowel diseases like ulcerative colitis and Crohn’s disease had until now been less clear. His study suggests that, similar to what happens in those other inflammatory conditions, increased levels of chronic inflammation from IBD may lead to premature development of cardiovascular disease.

“Clinicians that take care of patients who have traditional cardiovascular risk factors and IBD should also recognize IBD as an independent risk factor and treat appropriately,” he said in a web briefing for reporters hosted by the American College of Cardiology (ACC) ahead of their annual meeting. Panhwar is scheduled to present the study findings March 11, 2018, at the ACC 2018 Scientific Sessions in Orlando, FL.

Twenty-Somethings at Highest Risk

For the study, Panhwar and colleagues examined a database of electronic medical records for patients treated in 26 nationwide healthcare systems within the United States between 2014 and 2017. They identified 211,870 patients aged 18 to 65 years who had a diagnosis of IBD, comparing them with approximately 17.5 million non-IBD patients in the general population.

Compared with patients who did not have IBD, those who did had a higher percentage of hypertension, hyperlipidemia, diabetes, obesity, and smoking. Panhwar said one explanation for this could be that patients with IBD tend to have more contact with the healthcare system than patients without IBD.

“They tend to see more doctors, they tend to be in the hospital more often than patients without IBD,” he said. “Someone who’s never had any problems . . . may have hypertension that has not been diagnosed yet or diabetes that has not been diagnosed yet.”

Across all age groups, IBD patients had greater incidence of MI than those without these intestinal disorders. The overall prevalence of MI was 5.9% for the IBD cohort versus 3.5% for the non-IBD cohort. After adjusting for age, race, sex, and traditional cardiovascular risk factors, the IBD group was about 23% more likely to experience an MI than the non-IBD group.

Across age groups there was a clear upward trend in MI rates in IBD patients as age decreased, with a demarcation line around age 40. While rates of MI were low and similar for patients age 40 to 65, they began to climb in the under-40 groups, with the highest rates seen in patients aged 20 to 24 years.

Martha Gulati, MD (University of Arizona College of Medicine, Phoenix), editor-in-chief of ACC’s CardioSmart, who moderated the press briefing, pointed out that the much higher rate of smoking seen in the IBD cohort compared with the general population is not unusual because some Crohn’s disease patients, for example, find that smoking reduces their number of disease flare-ups.

“I think that one of the very interesting findings is the sex differences found here, the differences in young women especially,” Gulati said, adding that cardiovascular disease in young people often goes unrecognized because it is so unexpected.

She asked Panhwar if there is any evidence that therapies specific to IBD could lead to cardiovascular risk factors.

“As we all know, treatment for IBD involves everything from steroids to immunomodulators to biologics. Unfortunately, the design of the study didn’t let us really look at how treatment of IBD would affect the risk,” he said. “I think this is something that should be looked at in the future.” He characterized the study as a “bird’s-eye epidemiological view” of the problem that opens the door to more research in this area.