Major Acute Cardiovascular Events in Patients With Inflammatory Bowel Disease

Coron Artery Dis. 2020 Apr 16. doi: 10.1097/MCA.0000000000000899. Online ahead of print.

Gauravpal S Gill 1, Stephen J Fernandez 2, Nidhi Malhotra 1 3, Mihriye Mete 2, Hector M Garcia-Garcia 1


Author information

1Department of Medicine, MedStar Washington Hospital Center, Washington, DC.

2Department of Biostatistics and Informatics, MedStar Health Research Institute, Hyattsville, Maryland.

3Department of Medicine, Georgetown University, Washington, DC, USA.


Background: Systemic inflammation and immune-mediated diseases have been associated with ischemic heart disease in addition to traditional risk factors. In this study, we investigate associations between inflammatory bowel disease (IBD) and acute cardiovascular events.

Methods: An observational study where patient data were extracted from our health system patient pool of 3 917 894. Propensity scores were calculated for all 15 292 patients (0.39%) with IBD to assemble a 1:1 matched cohort balanced for age, gender, race and known cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus and smoking (current and former). Secondary analyses were performed independently for 6658 patients with ulcerative colitis and 9406 patients with Crohn's disease. ICD-9 and ICD-10 codes were used to identify cardiovascular risk factors and outcomes.

Results: Matched patients (n = 30 584) had a mean age of 51 years, with 58% being women, and 63% Caucasian. During the median follow-up of 4.4 years, all-cause mortality was observed in 1.7 versus 1.2% of patients from IBD and non-IBD groups, respectively [hazard ratio, 1.31; 95% confidence interval (CI), 1.08-1.58; P = 0.005]. Combined outcome for myocardial infarction or cardiovascular mortality was noted in 2.3 and 2.1% from IBD and non-IBD groups, respectively (hazard ratio, 1.04; 95% CI, 0.90-1.21; P = 0.588), while hazard ratios for cardiovascular mortality, myocardial infarction and unstable angina were 1.04 (0.74-1.47; P = 0.833), 1.05 (0.89-1.23; P = 0.591) and 1.10 (0.83-1.46; P = 0.524), respectively.

Conclusions: Among patients with IBD, incidence of acute coronary events did not show a statistically significant difference when compared to the matched cohort.

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