Inflammatory Bowel Disease an Independent Risk Factor for MI

Patients with inflammatory bowel disease (IBD) are at significantly higher risk for myocardial infarction (MI), particularly younger patients and women, compared with the general population, new research suggests.

The study emphasizes the need for closer monitoring and aggressive attention to cardiovascular risk factors, say the researchers.

"Patients with IBD who present with any cardiovascular complaints, including chest pain or shortness of breath, should be thoroughly evaluated by their physicians for a potential heart condition," lead investigators, Muhammad Panhwar, MD, and Mahazarin Ginwalla, MD, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio, advised in an email to | Medscape Cardiology.

"Our hope is that this study prompts clinicians who care for IBD patients to start thinking about IBD as an additional risk factor for heart disease and to also screen them and treat their risk factors aggressively," Panhwar and Ginwalla said.

The study was presented March 11 here at the American College of Cardiology (ACC) 2018 Annual Scientific Sessions.

Currently, there is a "lack of consensus" in the literature on the risk for MI in relation to IBD, noted Panhwar and Ginwalla. To investigate, they used the IBM Watson Explorys database, which collects electronic medical record data from 26 healthcare systems across the United States. Among more than 17.5 million adults in the database, 211,870 (1.2%) had IBD, which is in line with estimates by the US Centers for Disease Control and Prevention (CDC).

Adults with IBD were significantly (P < .001) more likely to have diabetes (15.9% vs 8.9%), hypertension (33.6% vs 21.9%), and dyslipidemia (27.8% vs 18.3%) and to smoke (20.7% vs 12.0%) compared with without IBD.

MI occurred roughly twice as often in adults with IBD as in controls (3.9% vs 1.65%; relative risk [RR], 2.4; 95% CI, 2.3 - 2.4). In a multivariable model adjusting for age, race, sex, and traditional cardiovascular risk factors, IBD remained associated with an elevated risk for MI (adjusted RR, 1.21; 95% CI, 1.19 - 1.23; P < .0001).

The risk was highest in younger adults and women with IBD. Typically, IBD is diagnosed between ages 15 and 30 years, and younger patients. Females are known to have more aggressive and disabling disease with more frequent flares, suggesting increased levels of inflammation. This disproportionate amount of inflammation in younger patients with IBD — who often don't have traditional cardiovascular risk factors — and women may explain why they had such a markedly higher risk for MI, the researchers point out.

Other chronic inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus, are also associated with increased risk for cardiovascular disease.

"Our study adds considerably to a growing set of literature highlighting the importance of chronic inflammation in IBD as having a role in the development of heart disease," Panhwar said in a conference statement.

This study shows that IBD is "another inflammatory disease associated with risk of MI," Robert Rosenson, MD, Mount Sinai Icahn School of Medicine, New York City, who wasn't involved in the study, told | Medscape Cardiology.

"People with IBD have an altered HDL proteome. There is a loss of anti-inflammatory proteins and more pro-inflammatory proteins carried by the HDL particle," rendering HDL "less protective" in people with IBD, Rosenson explained.

"This study," he said, "supports that these biomarker changes are important and related to higher risk of cardiovascular disease. It's unfortunate to see these results because many people are affected in childhood and young adulthood. They have a lifelong burden of inflammation and, of course, often debilitating bowel disease."

Rosenson said these data suggest that "maybe more immune-suppressing agents should be used and it would be important to establish whether greater use of these anti-TNF [tumor necrosis factor] agents or other therapies can alter the risk for MI."

The study had no commercial funding. The authors have disclosed no relevant financial relationships.

American College of Cardiology (ACC) 2018 Annual Scientific Session. Session 1262, Abstract 441. Presented March 11, 2018.

For more from | Medscape Cardiology

Medscape Medical News © 2018


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