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IBD should be viewed as independent risk factor for heart disease, say researchers

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Patients with inflammatory bowel disease are at increased risk of having a heart attack, regardless of traditional risk factors such as high cholesterol and high blood pressure, according to US researchers.

They found younger people between the aged between 18 and 24 were at the highest risk of myocardial infarction, tallying with existing knowledge on the progression of IBD.

“IBD should be considered an independent risk factor for heart disease”

Muhammad Panhwar

As a result of their findings, the researchers suggested that IBD should be considered as an independent risk factor for heart disease.

They highlighted that other studies had already shown that people with other chronic inflammatory conditions, such as lupus and rheumatoid arthritis, were at increased heart disease risk.

However, they said a link between IBD – the umbrella term covering Crohn’s disease and ulcerative colitis – and heart disease had previously only been a matter of debate.

To investigate a possible link between IBD and heart disease risk, they used a large database of around 17.5 million patients in the US.

They identified adult patients ages 18 to 65 with a diagnosis of IBD between 2014 and 2017 and looked at how many patients with and without IBD had heart attacks.

In total 211,870 (1.2%) had IBD. They were also more likely to have traditional risk factors for heart disease such as diabetes, high blood pressure, high cholesterol and smoking, than those without IBD.

Compared with patients who did not have IBD, heart attacks occurred roughly twice as often in those with IBD, noted the study authors.

After adjusting for age, race, sex and traditional heart disease risk factors, the researchers found that the patients with IBD had about a 23% higher risk of having a heart attack.

Women under the age of 40 with IBD were at higher risk for a heart attack than men with IBD in the same age group.

Meanwhile, in patients over the age of 40, heart attack risk was found to be similar for men and women with IBD.

The researchers highlighted that IBD was usually diagnosed between 15 and 30 years old, with younger patients and females known to have more aggressive and disabling disease characterised by more frequent flares, which suggested increased levels of inflammation.

“The results suggest clinicians should take seriously any symptoms suggestive of heart disease”

Muhammad Panhwar

They suggested that this disproportionate amount of inflammation in younger patients with IBD, who often do not have traditional cardiovascular risk factors, and women may explain why they had such a markedly higher risk of heart attacks.

The study authors suggested that clinicians who have patients with IBD should now be screening them for heart disease and focusing on risk reduction strategies.

They also said the study findings should “open the field” for more research into the link between IBD and heart disease, including the potential benefit of using anti-inflammatory drugs.

In addition, they said they hoped the findings would encourage IBD patients, especially those under 40, to have conversations with their clinician about their personal risk of cardiovascular disease.

Lead study author Dr Muhammad Panhwar, from Case Western Reserve University and the University Hospitals Cleveland Medical Center, said: “Our study adds considerably to a growing set of literature highlighting the importance of chronic inflammation in IBD as having a role in the development of heart disease.

“The results suggest clinicians should take seriously any symptoms suggestive of heart disease, such as chest pain, in patients with IBD, especially in younger patients,” he said.

He noted that younger patients had about nine times the risk of a heart attack compared to their peers in the same age group without IBD, but the risk “continued to decline with age”.

He added: “Our findings suggest that IBD should be considered an independent risk factor for heart disease.”

The new research was presented last month at the American College of Cardiology’s annual conference in Orlando, Florida.

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