Increased Prevalence of Myocardial Infarction and Stable Stroke Proportions in Patients with Inflammatory Bowel Diseases in Quebec in 1996-2015.

Petra Anna Golovics,Alain Bitton,Gustavo Drügg Hahn,Panu Wetwittayakhlang,Talat Bessissow,Gary E Wild,Christopher Filliter,Paul Brassard,Waqqas Afif,Lorant Gonczi,Peter L Lakatos,Christine Verdon

doi:10.3390/jcm11030686

Abstract

Background: Chronic inflammatory diseases are linked to an increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is controversial. We therefore examined the risk of and risk factors for myocardial infarction (MI) and stroke in IBD patients. Methods: We used the public health administrative database from the Province of Quebec, Canada, to identify IBD patients newly diagnosed between 1996 and 2015. The incidence and prevalence of MI and stroke in IBD patients were compared to those for the Canadian population. Results: A cohort of 35,985 IBD patients was identified. The prevalence but not incidence rates of MI were higher in IBD patients (prevalence: 3.98%; incidence: 0.234) compared to the Canadian rates (prevalence: 2.0%; incidence: 0.220), while the prevalence and incidence rates of stroke were not significantly higher in the IBD patients (prevalence: 2.98%; incidence: 0.122, vs. Canadian rates: prevalence: 2.60%; incidence: 0.297). We identified age, female gender, hyperlipidemia, diabetes, and hypertension (p < 0.001 for each) as significant risk factors associated with MI and stroke in IBD. Exposure to biologics was associated with a higher incidence of MI (IRR: 1.51; 95% CI: 0.82–2.76; p = 0.07) in the insured IBD population. Conclusions: An increased prevalence but not incidence of MI and no increased risk of stroke were identified in this population-based IBD cohort.

Highlights

Inflammatory bowel diseases (IBDs) are chronic, progressive, and disabling conditions mainly affecting young adults
Considering the major comorbidities, we found that 9.5% of the IBD patient had diabetes, 24.9% had hypertension, and 24.5% had hyperlipidemia
Female gender, hyperlipidemia, and hypertension (p < 0.001 for each) as risk factors for developing myocardial infarction (MI) and stroke in both Crohn’s disease (CD) and ulcerative colitis (UC) in the logistic-regression-based prevalence models (Tables 2–5), but not in all the Poisson-regression-based incidence models

Summary

Introduction

Inflammatory bowel diseases (IBDs) are chronic, progressive, and disabling conditions mainly affecting young adults. While cardiovascular diseases (CVDs) remain the primary cause of mortality and an essential public health concern in the developed world, a diverse set of inflammatory conditions (e.g., rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis) has previously been linked with the progression of atherogenesis and, increased cardiovascular outcomes [1]. Australia suggested that anti-TNF therapy was associated with a reduction in major cardiovascular events in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis [2]. Two recent meta-analysis showed a decreased incidence and mortality rate in psoriasis and psoriatic arthritis patients treated with anti-TNF therapy [3,4]. Chronic inflammatory diseases are linked to an increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is controversial. The incidence and prevalence of MI and stroke in IBD patients were compared to those for the Canadian population

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