Am J Med. 2021 Aug;134(8):1047-1051.e2. doi: 10.1016/j.amjmed.2021.02.029. Epub 2021 Apr 1.

Michelle T Lee ¹, Dhruv Mahtta ², Liang Chen ¹, Aliza Hussain ³, Mahmoud Al Rifai ³, Preetika Sinh ⁴, Umair Khalid ⁵, Khurram Nasir ⁶, Christie M Ballantyne ⁷, Laura A Petersen ¹, Salim S Virani ⁸

Author information

• ¹Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas; Section of Health Services Research, Department of Medicine.
• ²Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas; Section of Health Services Research, Department of Medicine; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
• ³Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
• ⁴Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee.
• ⁵Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
• ⁶Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Texas.
• ⁷Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas.
• ⁸Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Electronic address: virani@bcm.edu.

Abstract

Background: Recent literature has shown an association between atherosclerotic cardiovascular disease and inflammatory bowel disease, potentially mediated through chronic inflammatory pathways. However, there is a paucity of data demonstrating this relationship among young patients with premature atherosclerotic cardiovascular disease.

Methods: Using data from the nationwide Veterans wIth premaTure AtheroscLerosis (VITAL) registry, we assessed the association between extremely premature and premature atherosclerotic cardiovascular disease (age at diagnosis: ≤40 years and ≤55 years, respectively) and inflammatory bowel disease. Patients were compared with age-matched controls without atherosclerotic cardiovascular disease. Multivariable regression models adjusted for traditional risk factors.

Results: We identified 147,600 patients and 9485 patients with premature and extremely premature atherosclerotic cardiovascular disease, respectively. Compared with controls, there was a higher prevalence of overall inflammatory bowel disease among premature (0.96% vs 0.84%; odds ratio [OR] 1.14; 95% confidence interval [CI], 1.08-1.21) and extremely premature (1.36% vs 0.75%; OR 1.82; 95% CI, 1.52-2.17) patients. After adjustment, these associations attenuated in both premature and extremely premature groups (OR 1.07; 95% CI, 1.00-1.14 and OR 1.61; 95% CI, 1.34-1.94, respectively).

Conclusion: Inflammatory bowel disease is associated with higher odds of extremely premature atherosclerotic cardiovascular disease, especially for those age ≤40 years. With increasing age, this risk is attenuated by traditional cardiometabolic factors such as obesity, hypertension, diabetes, smoking, and dyslipidemia. Prospective studies are needed to assess the role of early intervention to decrease cardiovascular risk among young patients with inflammatory bowel disease.