1. 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; 106:741-747 2011.5.2 Hyun Hee Jae

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

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

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

12. Table 4. Development of combined CAD events by age

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

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

15. 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

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