title: Risk of Ischaemic Heart Disease in Patients with Inflammatory Bowel Disease: Cohort Study Using the General Practice Research Database.
abstract: OBJECTIVE
  Patients with inflammatory bowel disease (IBD) demonstrate an inflammatory response which bears some similarities to that seen in ischaemic heart disease (IHD). The nature of the association of IBD with IHD is uncertain. We aimed to define the extent and direction of that association.
  
  
  METHODS
  This retrospective cohort study examined records from patients aged ≥ 15 years with IBD from 1987-2009 (n = 19163) who were age and gender matched with patients without IBD (n = 75735) using the General Practice Research Database. The primary outcome was the hazard ratio for IHD.
  
  
  RESULTS
  A higher proportion of IBD patients had a recorded diagnosis of IHD ever, 2220 (11.6%) compared with 6504 (8.6%) of controls. However, the majority (4494, 51.5%) developed IHD prior to IBD diagnosis (1404 (63.2%) of IBD cases and 3090 (47.5%) of controls). There was increased IHD incidence in the first year after IBD diagnosis. Mean age at IHD diagnosis was statistically similar across all IBD groups apart from for those with Ulcerative Colitis (UC) who were slightly younger at diagnosis of angina compared to controls (64.5y vs. 67.0y, p = 0.008) and coronary heart disease (65.7y vs.67.9y, p = 0.015). Of those developing IHD following IBD diagnosis, UC patients were at higher risk of IHD (unadjusted HR 1.3 (95% CI 1.1-1.5), p<0.001) or MI (unadjusted HR 1.4 (95% CI 1.1-1.6), p = 0.004).
  
  
  CONCLUSIONS
  Although IHD prevalence was higher in IBD patients, most IHD diagnoses predated the diagnosis of IBD. This implies a more complex relationship than previously proposed between the inflammatory responses associated with IHD and IBD, and alternative models should be considered.
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Close
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: James M
authors.initials: JM
authors.lastname: Mason
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Wilson
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: A Pali S
authors.initials: AP
authors.lastname: Hungin
authors.affiliation: Department of General Practice and Primary Care, King's College, London, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D058006:General Practice; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology*; D016016:Proportional Hazards Models; D013997:Time Factors; D055815:Young Adult