title: Steroid exposure, acute coronary syndrome, and inflammatory bowel disease: insights into the inflammatory milieu.
abstract: BACKGROUND
  Steroids are anti-inflammatory agents commonly used to treat inflammatory bowel disease. Inflammation plays a critical role in the pathophysiology of both inflammatory bowel disease and acute coronary syndrome. We examined the relationship between steroid use in patients with inflammatory bowel disease and acute coronary syndrome.
  
  
  METHODS
  In 177 patients with inflammatory bowel disease (mean age 67 years, 75% male, 44% Crohn's disease, 56% ulcerative colitis), we performed a 1:2 case-control study matched for age, sex, and inflammatory bowel disease type, and compared 59 patients with inflammatory bowel disease with acute coronary syndrome to 118 patients with inflammatory bowel disease without acute coronary syndrome. Steroid use was defined as current or prior exposure. Acute coronary syndrome was defined as myocardial infarction or unstable angina, confirmed by cardiac biomarkers and coronary angiography.
  
  
  RESULTS
  In patients with inflammatory bowel disease, 34% with acute coronary syndrome had exposure to steroids, vs 58% without acute coronary syndrome (P < .01). Steroid exposure reduced the adjusted odds of acute coronary syndrome by 82% (odds ratio [OR] 0.39; 95% confidence interval [CI], 0.20-0.74; adjusted OR 0.18; 95% CI, 0.06-0.51) in patients with inflammatory bowel disease, 77% in Crohn's disease (OR 0.36; 95% CI, 0.14-0.92; adjusted OR 0.23; 95% CI, 0.06-0.98), and 78% in ulcerative colitis (OR 0.41; 95% CI, 0.16-1.04; adjusted OR 0.22; 95% CI, 0.06-0.90). There was no association between other inflammatory bowel disease medications and acute coronary syndrome.
  
  
  CONCLUSIONS
  In patients with inflammatory bowel disease, steroid use significantly reduces the odds of acute coronary syndrome. These findings provide further mechanistic insight into the inflammatory processes involved in inflammatory bowel disease and acute coronary syndrome.
authors.affiliation: Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pearl
authors.initials: P
authors.lastname: Zakroysky
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Wai-Ee
authors.initials: WE
authors.lastname: Thai
authors.affiliation: Division of Cardiovascular Disease, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Roderick C
authors.initials: RC
authors.lastname: Deaño
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basnet
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Zurine Galvan
authors.initials: ZG
authors.lastname: Onandia
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sachin
authors.initials: S
authors.lastname: Gandhi
authors.affiliation: Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tawakol
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016001:Confidence Intervals; D017023:Coronary Angiography; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D014336:Troponin / Q000097:blood; D014481:United States
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D005938:Glucocorticoids; D014336:Troponin
keywords: Acute coronary syndrome; Crohn's disease; Inflammatory bowel disease; Steroids; Ulcerative colitis