Inflammatory Bowel Disease Is Associated With an Increased Incidence of Cardiovascular Events Andres J. Yarur, MD, Amar R. Deshpande, MD, David M. Pechman, BS, Leonardo Tamariz, MD, MPH, Maria T. Abreu, MD and Daniel A. Sussman, MD Am J Gastroenterol 2011; 106: Hyun Hee Jae

Introduction  Inflammatory bowel disease  Several extraintestinal manifestations  Chronic inflammation  Hypercoagulable states  Several inflammatory mediators  CRP, TNF-a, CD40 ligand etc…  In both IBD and atherosclerosis

Introduction  Patients with IBD  A higher risk of developing early atherosclerosis  Increased carotid intima – media thickness  No definitive studies  Incidence of coronary artery disease in IBD patients

Introduction  Hypothesis in this study  Patients with IBD  A higher rate of cardiovascular events than the general outpatient population  The rate of CAD : Traditional and nontraditional cardiovascular risk factors

Methods  Retrospective longitudinal cohort study with matched controls  Medical records review

Methods  Patients  Resided in the state of Florida  >18 years of age  Medical care at Jackson Memorial Hospital in Miami, Florida  Embraced all patients with either Crohn’s disease or ulcerative colitis  Between January 1995 and December 2009  Unexposed group  At least twice yearly in the health maintenance clinic of the same institution  For each patient with IBD, two control subjects  Matching for age, gender, and city of residence

Methods  Traditional risk factors  Hypertension, diabetes mellitus, smoking status, dyslipidemia, family histoly of CAD, chronic kidney disease, obesity  Defined by the established diagnostic criteria  Nontraditional risk factors  WBC count, hemoglobin, platelet count, ESR, CRP  Steroid exposure  >90 days, <90 days  >20mg, <20mg

Methods  Outcomes  Primary outcome  The development of a CAD event  Acute coronary syndrome (unstable angina and MI)  In the IBD subgroup – at least 12 months after the diagnosis of IBD  Secondary outcome  The development of heart failure and the need for percutaneous or surgical revascularization

Results  Study population  356 patients with IBD  173 : crohn’s disease  183 : ulcerative colitis  712 matched non-IBD controls  Mean time of follow-up  53 months for the IBD subjects  51 months for the non-IBD subjects

Table 1. Baseline cardiovascular and inflammatory risk factors in IBD cases and controls

Table 3. Risk of CAD in IBD and non-IBD patients

Table 4. Development of combined CAD events by age

Table 5. Multivariate influence of CV risk factors on total CAD events

Figure 1. Impact of traditional CV risk factors on combined CAD events

Conclusion  Increased incidence of CAD events in IBD pts.  despite having a lower burden of traditional risk factors  Traditional risk factors  A lower impact on CAD development in the IBD group  Further investigation  How nontraditional risk factors in IBD pts. Change CAD risk

Table 2. Predictor factors and outcomes stratified by type of IBD