title: Disease activity in inflammatory bowel disease is associated with increased risk of myocardial infarction, stroke and cardiovascular death--a Danish nationwide cohort study.
abstract: OBJECTIVE
  Chronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is unclear. We therefore examined the risk of myocardial infarction (MI), stroke, and cardiovascular death in patients with IBD.
  
  
  METHODS
  In a nationwide Danish population-based setting, a cohort of patients with incident IBD between 1996 and 2009 were identified in national registers. Hospitalizations with IBD as primary diagnosis, initiation of biological treatment and dispensed prescriptions of corticosteroids were all used as surrogate markers for disease activity, with flares classified as the first 120 days after diagnosis of IBD, and 120 days after a new corticosteroid prescription, biological treatment or IBD hospitalization, respectively. Continued corticosteroid prescriptions or IBD hospitalizations were defined as persistent activity, and periods free of such events were defined as remissions. Poisson regression was used to examine risk of MI, stroke, and cardiovascular death using a matched population-based comparison cohort as reference.
  
  
  RESULTS
  We identified 20,795 IBD patients with a mean age of 40.3 years that were matched according to age and sex with 199,978 controls. During the study period, there were 365 patients with MI, 454 with stroke, and 778 with cardiovascular death. Patients with IBD had an overall increased risk of MI (rate ratio [RR] 1.17 [95% confidence interval 1.05-1.31]), stroke (RR 1.15 [1.04-1.27], and cardiovascular death (RR 1.35 [1.25-1.45]). During flares and persistent IBD activity the RRs of MI increased to 1.49 (1.16-1.93) and 2.05 (1.58-2.65), the RRs of stroke to 1.53 (1.22-1.92) and 1.55 (1.18-2.04) and for cardiovascular death 2.32 (2.01-2.68) and 2.50 (2.14-2.92). In remission periods, the risk of MI, stroke and cardiovascular death was similar to controls.
  
  
  CONCLUSIONS
  Inflammatory bowel disease is associated with increased risk of MI, stroke, and cardiovascular death during periods with active disease.
authors: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. slk@heart.dk
authors: Søren Lund
authors: SL
authors: Kristensen
authors: Ole
authors: O
authors: Ahlehoff
authors: Jesper
authors: J
authors: Lindhardsen
authors: Rune
authors: R
authors: Erichsen
authors: Gunnar Vagn
authors: GV
authors: Jensen
authors: Christian
authors: C
authors: Torp-Pedersen
authors: Ole Haagen
authors: OH
authors: Nielsen
authors: Gunnar Hilmar
authors: GH
authors: Gislason
authors: Peter Riis
authors: PR
authors: Hansen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology*; D012306:Risk; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*