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P102 Subclinical atherosclerosis assessed by coronary artery calcium score in patients with Crohn’s disease

B. Rocha*1, C. Nomura2, M. Rocha2, B. Lopes2, M. Azevedo1, A. Carlos1, F. Carrillo1, A. Damiao1, A. Sipahi1, A. Leite1

1University of São Paulo Medical School, Department of Gastroenterology and Hepatology, São Paulo, Brazil, 2University of São Paulo Medical School, Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, São Paulo, Brazil

Background

Several immune-mediated diseases such as rheumatoid arthritis, systemic lupus erythematosus and psoriasis are associated with an increased risk of cardiovascular disease (CVD).1 However, there are conflicting data as to whether inflammatory bowel diseases (IBD) increase risk for CVD.2 We aimed to evaluate coronary artery calcium (CAC) score as an accurate predictor of cardiovascular event in patients with Crohn’s disease.

Methods

We investigated 150 patients with Crohn’s disease (mean age, 43.4 ± 5.9 years) and 75 age- and sex-matched controls (mean age, 43.6 ± 5.6 years) without prior known CVD and traditional risk factors for atherosclerosis such as hypertension, dyslipidemia, diabetes, smoking, obesity, and family history of coronary disease. All participants underwent a computed tomography for the measurement of CAC and the calcification extent was measured by means of the Agatston score. CAC was considered a qualitative variable (CAC = 0 and CAC > 0).

Results

The two groups were similar in respect to age, sex and Framingham risk score. Nevertheless, there were differences in body mass index, systolic blood pressure and lipid profile, even though all these parameters were within normal range in both groups. Serum C reactive protein and albumin differed between groups.

Table 1. General characteristics of patients with Crohn and control subjects

Patients (n = 150)Controls (n = 75)p-value
Age (years)43.4 ± 5.943.6 ± 5.60.72
Male78 (52%)39 (52%)1.00
Body mass index (kg/m2)23 ± 324 ± 20.007
Systolic blood pressure (mmHg)115 ± 14119 ± 130.05
C reactive protein (mg/l)6.24 ± 11.01.99 ± 3.170.0003
Low-density lipoprotein (mg/dl)88 ± 33107 ± 26<0.001
High-density lipoprotein (mg/dl)53 ± 1457 ± 150.05
Triglycerides (mg/dl)103 ± 3897 ± 400.19
Framingham risk score (%)1.6 ± 1.61.7 ± 1.40.38

CAC score > 0 was observed in 11 of 150 patients and in 5 of 75 control subjects with no significant difference between groups (p = 1.0).

Abstract PO102 – Figure 1. Prevalence of coronary artery calcification (CAC) among patients with Crohn’s disease and control subjects

Among patients with Crohn, disease activity scores, years since diagnosis and the use of immunomodulators and/or biologic therapy were similar in those with and without coronary artery calcification. Those with calcification were older (p = 0.022) and more likely to be male (p = 0.058).

Abstract PO102 – Table 2. Characteristics of patients with Crohn according to the CAC score

CAC = 0 (n = 139)CAC > 0 (n = 11)p-value
Age (years)43.1 ± 5.948.1 ± 5.20.022
Male69 (50%)9 (82%)0.058
Duration of disease (years)15 ± 617 ± 50.13
C reactive protein (mg/l)6.1 ± 11.16.9 ± 10.80.80
CDAI* (mean)129 ± 96102 ± 750.39
Harvey–Bradshaw (mean)3 ± 32 ± 20.80
Under Azathioprine or Methotrexate therapy94 (68%)7 (64%)0.74
Under anti-TNF therapy76 (55%)7 (64%)0.74

*Crohn's disease activity index.

Conclusion

The current findings show that patients with Crohn’s disease without traditional cardiovascular risk factors do not exhibit higher coronary artery calcification. Cardiovascular risk is still a conflicting issue in IBD and further studies are needed to clarify the relationship between CVD and IBD.

References

1. Staniak HL, Bittencourt MS, de Souza Santos I, et al. Association between psoriasis and coronary calcium score. Atherosclerosis 2014;237:847–52.

2. Osterman MT, Yang Y-X, Brensinger C, et al. No increased risk of myocardial infarction among patients with ulcerative colitis or Crohn’s disease. Clin Gastroenterol Hepatol 2011;9:875–80.