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DOP45 Increased prevalence but not incidence of myocardial infarction and stroke in patients with inflammatory bowel diseases in Quebec in 1996–2015

C. Verdon1, J. Reinglas1, C. Filliter1, J. Coulombe1, L. Gonczi2, W. Afif1, G. Wild1, E. Seidman1, A. Bitton1, T. Bessissow1, P. Brassard1, P.L. Lakatos PhD1,2

1Division of Gastroenterology, McGill University, Montreal, Canada, 2Department of Medicine I, Semmelweis University, Budapest, Hungary

Background

Chronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is conflictive. We, therefore, examined the risk of and risk factors for myocardial infarction (MI) and stroke in patients with IBD in Quebec.

Methods

We used the public health administrative database from the Province of Québec to identify newly diagnosed IBD patients between 1996 and 2015 with established case ascertainment algorithm. Incidence and prevalence of stroke and myocardial infarction were defined using ICD codes found in primary, secondary care visits or admission. Comorbidity analysis was performed by both using a logistic regression or a Poisson model with outcome rates for 1000 person-years adjusted for age and sex along with one comorbidity of interest, or with medical therapy as a time-varying variable. Significant variables (p < 0.05) were added to a multivariable models along with age and sex. Analyses were run overall and stratified by disease type. Incidence rate ratios, 95% CIs and p-values were computed.

Results

In total, 34 644 newly diagnosed IBD patients (CD: 59.5%) were identified. The prevalence but not incidence rates of MI was higher in IBD (prevalence at the end on 2013: 3.98%, OR:2.03 95% CI: 1.92–2.15, incidence: 0.234 per 1000 patient-years) compared with the background Canadian rates (prevalence in 2012–2013: 2.0%, incidence: 0.220 per 1000 patient-years), while the prevalence and incidence rates of stroke were not significantly higher in IBD (prevalence in 2012–2013: 2.98%, OR: 1.15 95% CI:1.08–1.23, incidence: 0.122 per 1000 patient-years vs Canadian rates: (prevalence in 2012–2013: 2.60%, incidence: 0.297 per 1000 patient-years). We identified age, sex, hyperlipidaemia and hypertension (p < 0.001 for each) as risk factors for developing MI and stroke in both CD and UC. Diabetes was identified as an additional risk factor for MI in CD and stroke in UC. Exposure to biologicals was associated with a higher incidence of MI compared with the non-treatment group (IRR: 1.51, 95% CI: 0.82–2.76, p = 0.07) in the insured IBD population.

Conclusion

Increased prevalence but not incidence of MI and no increased risk of stroke was identified in this population-based IBD cohort from Quebec. Risk factors for both MI and stroke included age, sex, hyperlipidaemia, hypertension and diabetes in IBD. Exposure to biologicals, reflecting disease severity in administrative databases, was associated with a higher incidence rate ratio for MI in IBD.

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