Inflammatory bowel disease tied to heart attack risk

[December 14, 2018]  By Lisa Rapaport

(Reuters Health) - - People with inflammatory bowel diseases like Crohn's disease and ulcerative colitis may be up to 12 times more likely to have a heart attack, a U.S. study suggests.

Inflammatory bowel disease (IBD) involves chronic or recurring inflammation of the gastrointestinal tract. Ulcerative colitis and Crohn's are the most common forms. People with Crohn's have inflammation throughout the digestive tract, while in ulcerative colitis, only the large intestine is inflamed.

While chronic inflammation in the body has long been linked to an increased risk of cardiovascular disease, the potential for conditions like Crohn's disease and ulcerative colitis to lead to heart attacks isn't as well understood, the study team notes in the journal Inflammatory Bowel Diseases.

The researchers examined a nationwide database of medical records for more than 29 million people, including almost 132,000 with ulcerative colitis and 159,000 with Crohn's disease.

Over the five-year study period, people with IBD were 25 percent more likely than those without the disorder to have a heart attack, the study found.

"IBD should be regarded as an independent risk factor for the development of heart disease," said senior author Dr. Mahazarin Ginwalla of University Hospitals Cleveland Medical Center in Ohio.

This means people with IBD should be monitored carefully for cardiac risk factors like smoking, obesity, high blood pressure, diabetes and high cholesterol, Ginwalla said by email. Treating risk factors, and keeping symptoms of IBD controlled, may lower the risk of heart attacks, Ginwalla said.

For people with IBD, "the risk of adverse cardiovascular events is highest during active flares or persistent disease, with this risk diminishing during times of remission," Ginwalla added.

During the study, 3.3 percent of people without IBD had a heart attack, compared to 6.7 percent of patients with ulcerative colitis and 8.8 percent of individuals with Crohn's disease.

The biggest increased risk of heart attacks for people with IBD was seen among younger people.

IBD patients ages 30 to 34 were 12 times more likely to have a heart attack than people in their age group without IBD, the study found.

By age 65, however, people with IBD were only about twice as likely to have a heart attack as people without these conditions.

It's possible that chronic inflammation in people with IBD might lead to clotting in the blood and more clots in the arteries, which then leads to heart attacks, said Dr. Miguel Regueiro of Cleveland Clinic in Ohio.

"The IBD is probably indirectly causing the heart attack from the body's response to inflammation," Regueiro, who wasn't involved in the study, said by email.

The results add to growing evidence that patients with IBD may be at increased risk for heart attacks, said Dr. Gilaad Kaplan of the University of Calgary in Canada.

"With this knowledge, it is important that patients with IBD minimize their future risk by talking to their primary care doctor about risk factor modifications," Kaplan, who wasn't involved in the study, said by email. This includes a healthy diet, smoking cessation, controlling blood pressure and cholesterol, and managing diabetes, Kaplan advised.

SOURCE: https://bit.ly/2EjvNYy Inflammatory Bowel Diseases, online November 30, 2018.

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