title: Inflammatory bowel disease is associated with an increased risk of hospitalization for heart failure: a Danish Nationwide Cohort study.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) has been linked to adverse cardiovascular events, but a relation to heart failure (HF) is uncertain. We investigated the IBD-associated risk of HF in a nationwide setting.
  
  
  RESULTS
  A total of 5 436 647 Danish citizens, with no history of IBD or HF, were included on January 1, 1997, and followed up until first hospitalization for HF, death, or December 31, 2011. Of these subjects, 23 681 developed IBD for which disease activity was determined continuously throughout the study. The risk of hospitalization for HF was estimated with a Poisson regression model adjusting for comorbidity and cardiovascular pharmacotherapy as time-dependent covariates. During a mean follow-up of 11.8 years in the reference population and 6.4 years in the IBD group, hospitalization for HF occurred in 553 subjects with IBD and 171 405 in the reference population. Patients with IBD had a 37% increased risk of hospitalization for HF (incidence rate ratio, 1.37; 95% confidence interval, 1.26-1.49) compared with the reference population. IBD activity-specific analyses showed markedly increased risk of HF hospitalization during flares (incidence rate ratio, 2.54; 95% confidence interval, 2.13-3.04) and persistent activity (incidence rate ratio, 2.73; 95% confidence interval, 2.25-3.33) but not in IBD remission (incidence rate ratio, 1.04; 95% confidence interval, 0.94-1.16).
  
  
  CONCLUSIONS
  In a nationwide cohort, IBD was associated with an increased risk of hospitalization for HF, and this risk was strongly correlated to periods of active disease. The mechanisms underlying this finding warrant further studies.
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.). slk@heart.dk.
authors: Søren Lund
authors: SL
authors: Kristensen
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Ole
authors: O
authors: Ahlehoff
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Jesper
authors: J
authors: Lindhardsen
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Rune
authors: R
authors: Erichsen
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Morten
authors: M
authors: Lamberts
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Usman
authors: U
authors: Khalid
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Ole Haagen
authors: OH
authors: Nielsen
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Christian
authors: C
authors: Torp-Pedersen
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Gunnar Hilmar
authors: GH
authors: Gislason
authors: From the Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark (S.L.K., O.A., J.L., M.L., U.K., G.H.G., P.R.H.); Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark (O.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (R.E.); Department of Gastroenterology, Copenhagen University Hospital Herlev, Herlev, Denmark (O.H.N.); Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
authors: Peter Riis
authors: PR
authors: Hansen
mesh_terms: D000328:Adult; D015897:Comorbidity / Q000639:trends; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Crohn disease; colitis, ulcerative; heart failure; inflammation; inflammatory bowel diseases