title: Risk of cerebrovascular accidents and ischemic heart disease in patients with inflammatory bowel disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolic disease. However, it is unclear whether IBD modifies the risk of arterial thromboembolic events, including cerebrovascular accidents (CVA) and ischemic heart disease (IHD).
  
  
  METHODS
  We performed a systematic review and meta-analysis of cohort and case-control studies that reported incident cases of CVA and/or IHD in patients with IBD and a non-IBD control population (or compared with a standardized population). We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  We analyzed data from 9 studies (2424 CVA events in 5 studies, 6478 IHD events in 6 studies). IBD was associated with a modest increase in the risk of CVA (5 studies; OR, 1.18; 95% CI, 1.09-1.27), especially among women (4 studies; OR, 1.28; 95% CI, 1.17-1.41) compared with men (OR, 1.11; 95% CI, 0.98-1.25), and in young patients (<40-50 y old). The increase in risk was observed for patients with Crohn's disease and in those with ulcerative colitis. IBD also was associated with a 19% increase in the risk of IHD (6 studies; OR, 1.19; 95% CI, 1.08-1.31), both in patients with Crohn's disease and ulcerative colitis. This risk increase was seen primarily in women (4 studies; OR, 1.26; 95% CI, 1.18-1.35) compared with men (OR, 1.05; 95% CI, 0.92-1.21), in young and old patients. IBD was not associated with an increased risk of peripheral arterial thromboembolic events. Considerable heterogeneity was observed in the overall analysis.
  
  
  CONCLUSIONS
  IBD is associated with a modest increase in the risk of cardiovascular morbidity (from CVA and IHD)-particularly in women. These patients should be counseled routinely on aggressive risk factor modification.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors: Siddharth
authors: S
authors: Singh
authors: Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors: Harkirat
authors: H
authors: Singh
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors: Edward V
authors: EV
authors: Loftus
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: pardi.darrell@mayo.edu.
authors: Darrell S
authors: DS
authors: Pardi
mesh_terms: D016022:Case-Control Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D017202:Myocardial Ischemia / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*
keywords: Coronary Artery Disease; Inflammatory Bowel Disease; Myocardial Infarction; Stroke