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OP003 Increased risk of acute arterial events in young patients with severely active inflammatory bowel disease: a nationwide French cohort study

Kirchgesner J.*1,2, Beaugerie L.1, Carrat F.3,4, Nyboe Andersen N.5, Jess T.5,6, Schwarzinger M.7,8 For the BERENICE Study Group

1Saint-Antoine Hospital, AP-HP, Gastroenterology, Paris, France 2INSERM, University Paris 06, UMR S 1136, Paris, France 3Hopital Saint Antoine, Department of Public Health, Paris, France 4INSERM, University Paris 06, UMR S 1136, Paris, France 5Statens Serum Institute, Department of Epidemiology Research, Copenhagen, Denmark 6Frederiksberg Hospital, Institute of Preventive Medicine, Frederiksberg, Denmark 7INSERM, UMR 1137, Paris, France 8THEN, Translational Health Economics Network, Paris, France

Background

Magnitude and independent drivers of the risk of acute arterial events in inflammatory bowel disease (IBD) are still unclear. We addressed this question in IBD patients compared to the general population at a nationwide level.

Methods

Using the French National Hospital Discharge Database from 2008 to 2013, all patients aged 15 years or older and diagnosed with IBD were identified and followed up until 31 December 2013. Occurrence of acute arterial events, cardiovascular risk factors (hypertension, hyperlipidemia, diabetes, obesity, smoking behavior, and alcohol use disorder), surgical procedures, and hospitalizations related to IBD were assessed. Acute arterial events included ischemic heart disease, cerebrovascular disease and peripheral artery disease excluding acute mesenteric ischemia. Incidence of first acute arterial event in patients with IBD and expected incidence for each region-, sex-, and 5-year age-specific stratum based on observed incidence in the French general population were calculated. The impact of severe disease activity marker (recent hospitalization for uncontrolled IBD) was assessed among IBD patients by survival analysis adjusted for cardiovascular risk factors.

Results

A total of 210,162 individuals with IBD (Crohn's disease [CD], n=97,708; ulcerative colitis [UC], n=112,454) were included. During 595,202 person-years of follow-up, 5554 IBD patients were diagnosed with incident acute arterial events, including 3177 ischemic heart diseases (57.2%), 1715 cerebrovascular diseases (30.9%) and 662 peripheral artery diseases (11.9%). Patients with CD (Standardized incidence ratio (SIR), 1.35; 95% CI, 1.30–1.41) and UC (SIR, 1.10; 95% CI, 1.06–1.13) had an increased risk of acute arterial events overall (Table). Higher values were observed in patients aged less than 35 years, both in CD (SIR, 1.42; 95% CI: 1.09–1.75) and UC (SIR, 1.65; 95% CI, 1.20–2.10). During follow-up, 22% and 13% of CD and UC patients were hospitalized for IBD-related symptoms. After adjustment for general cardiovascular risk factors, the 3-month periods before and after IBD-related hospitalization were associated with an increased risk of acute arterial events compared with other periods in patients with CD and UC (Hazard ratio, 1.77; 95% CI, 1.47–2.12 and 1.87; 95% CI, 1.58–2.22).

Table 1. Standardized Incidence Ratios (SIRs) of acute arterial events, by IBD subtype

Reported casesExpected casesSIR (95% CI)p value
Crohn's disease (287,134 person-years)
 All acute arterial events224416581.35 (1.30–1.41)<0.0001
 Ischemic heart disease12539561.31 (1.24–1.38)<0.0001
 Cerebrovascular disease6945231.33 (1.23–1.43)<0.0001
 Peripheral artery disease2971801.65 (1.46–1.83)<0.0001
Ulcerative colitis (308,068 person-years)
 All acute arterial events331030211.10 (1.06–1.13)<0.0001
 Ischemic heart disease192417501.10 (1.05–1.15)<0.0001
 Cerebrovascular disease10219231.11 (1.04–1.17)<0.01
 Peripheral artery disease3653411.07 (0.96–1.18)0.21

Conclusion

Patients with IBD are at increased risk of acute arterial events, with the highest risk in young patients. Disease activity may also have an independent impact on the risk and, in addition to smoking status, may partly account for differences in CD and UC.