Chronic intestinal inflammation associated with IBD may have systemic consequences outside of the gut. The significance of thorough inflammation management to lower cardiovascular risk in IBD patients is highlighted by recent studies showing that both histologic and clinical disease activity are associated with an elevated risk of significant adverse cardiovascular events. Thus, this study examined the impact of clinically active IBD (against quiescent IBD) and histologic inflammation (vs histologic remission) on the risk of MACE in this statewide, population-based sample.
A total of 59,168 IBD patients diagnosed between 1969 and 2017 with histologic examination and 91,800 patients diagnosed between 1969 and 2020 with clinical activity assessment between 2006 and 2021 participated in this countrywide cohort study in Sweden. MACE, a composite outcome that includes heart failure, stroke, and ischemic heart disease, were the main outcome. The adjusted hazard ratios (aHRs) of MACE and its subcomponents were calculated using the Cox proportional hazards model.
Histologic inflammation (n = 868, incidence rate [IR]: 86.3/10,000 person-years) was associated with a higher risk of MACE than remission (n = 558, IR = 71.3) (aHR = 1.16 [1.04–1.30]). Crohn's disease (aHR = 1.30 [1.03–1.64]) and ulcerative colitis (aHR = 1.13 [1.01–1.27]) also showed this increased risk. In contrast to hemorrhagic stroke, histologic inflammation was linked to an increased risk of ischemic heart disease, myocardial infarction, ischemic stroke, and heart failure.
Active IBD was linked to a higher risk of MACE (IR: 131.4 vs. 93.7; aHR = 1.54 [1.46–1.63]) and all MACE subcomponents when compared to clinically quiescent IBD. istologic inflammation was still associated with heart failure (aHR = 1.19 [1.00–1.43]) and myocardial infarction (aHR = 1.29 [1.06–1.58]) in individuals with clinically quiescent IBD.
Overall, the histologic and clinical activity of IBD was linked to later MACE, such as myocardial infarction, ischemic stroke, and heart failure, according to this countrywide cohort research. Even in individuals with clinically quiescent IBD, there was a higher risk of myocardial infarction and heart failure with histologic inflammation.
Source:
Sun, J., Mårild, K., Sundström, J., Bergman, D., SWIBREG Study Group, Ebrahimi, F., Halfvarson, J., Olén, O., & Ludvigsson, J. F. (2025). Association of histologic and clinical activity with major adverse cardiovascular events in patients with inflammatory bowel disease: A cohort study. Journal of Internal Medicine, joim.70035. https://doi.org/10.1111/joim.70035
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