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Inflammatory bowel disease
Original article
Increased risk of acute arterial events in young patients and severely active IBD: a nationwide French cohort study
  1. Julien Kirchgesner1,2,
  2. Laurent Beaugerie1,3,
  3. Fabrice Carrat2,4,
  4. Nynne Nyboe Andersen5,6,
  5. Tine Jess5,6,7,
  6. Michaël Schwarzinger8,9
  7. for the BERENICE study group
  1. 1 Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France
  2. 2 UMRS 1136, INSERM, UPMC Univ Paris 06, Sorbonne Universités, Paris, France
  3. 3 ERL 1057, INSERM/UMRS 7203 and GRC-UPMC 03, UPMC Univ Paris 06, Paris, France
  4. 4 Department of Public Health, AP-HP, Hôpital Saint-Antoine, Paris, France
  5. 5 Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
  6. 6 Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
  7. 7 Department of Clinical Epidemiology, Bispebjerg Hospital, Copenhagen, Denmark
  8. 8 Translational Health Economics Network, Paris, France
  9. 9 Infection Antimicrobials Modeling and Evolution, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  1. Correspondence to Dr Julien Kirchgesner, Service de Gastroentérologie et Nutrition, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75571 Paris CEDEX 12, France; julien.kirchgesner{at}gmx.com

Abstract

Objective Magnitude and independent drivers of the risk of acute arterial events in IBD are still unclear. We addressed this question in patients with IBD compared with the general population at a nationwide level.

Design Using the French National Hospital Discharge Database from 2008 to 2013, all patients aged 15 years or older and diagnosed with IBD were identified and followed up until 31 December 2013. The rates of incident acute arterial events were calculated and the impact of time with active disease (period around hospitalisation for IBD flare or IBD-related surgery) on the risk was assessed by Cox regression adjusted for traditional cardiovascular risk factors.

Results Among 210 162 individuals with IBD (Crohn’s disease (CD), n=97 708; UC, n=112 454), 5554 incident acute arterial events were identified. Both patients with CD and UC had a statistically significant overall increased risk of acute arterial events (standardised incidence ratio (SIR) 1.35; 95% CI 1.30 to 1.41 and SIR 1.10; 95 CI 1.06 to 1.13, respectively). The highest risk was observed in patients under the age of 55 years, both in CD and UC. The 3-month periods before and after IBD-related hospitalisation were associated with an increased risk of acute arterial events in both CD and UC (HR 1.74; 95 CI 1.44 to 2.09 and 1.87; 95% CI 1.58 to 2.22, respectively).

Conclusion Patients with IBD are at increased risk of acute arterial events, with the highest risk in young patients. Disease activity may also have an independent impact on the risk.

  • Inflammatory bowel disease
  • cardiovascular disease
  • ischemic heart disease
  • cerebrovascular disease
  • peripheral arterial disease.

https://doi.org/10.1136/gutjnl-2017-314015

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    Footnotes

    • Contributors JK: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis. LB: study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. FC: analysis and interpretation of data, critical revision of the manuscript for important intellectual content. NNA: analysis and interpretation of data, critical revision of the manuscript for important intellectual content. TJ: study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. MS: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, study supervision.

    • Funding The BERENICE project is supported by grants from the French National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament (ANSM)).

    • Competing interests LB has received lecture fees from Abbott, Abbvie, MSD, Ferring Pharmaceuticals, Janssen, and research support from Abbott, Biocodex and Ferring Pharmaceuticals. NNA has received lecture fees from MSD and Ferring. MS is an employee of Translational Health Economics Network (THEN), Paris, France that received research grants of Abbvie, Gilead, Merck and co, Novartis, outside and unrelated to the submitted work.

    • Patient consent All data used in this study only contained anonymous patient records.

    • Ethics approval The French Data Protection Agency (CNIL)

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All analyses are included in the main manuscript or online supplementary material.

    • Collaborators Collaborators of the BERENICE study group are the following: Laurent Beaugerie, Anne-Marie Bouvier, Anne Buisson, Franck Carbonnel, Fabrice Carrat, Jacques Cosnes, Corinne Gower-Rousseau, Julien Kirchgesner, Alain Olympie, Laurent Peyrin-Biroulet, Jean-François Rahier, Frank Ruemmele, Michaël Schwarzinger, Tabassome Simon, Yazdan Yazdanpanah.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.