Patients with inflammatory bowel disease (IBD) are at a significantly higher risk of myocardial infarction (MI), says a study reported in the journal Inflammatory Bowel Diseases, online November 30, 2018. The relative risk of MI was highest in younger patients and decreased with age.

The researchers examined a nationwide database of medical records for more than 29 million people, of which, 131,680 had ulcerative colitis and 158,750 had Crohns disease. Over the 5-year study period, patients with IBD had 25% greater probability to suffer a heart attack when compared to those without IBD.

Around 8.8% of patients with Crohns disease suffered a heart attack during the study period. Likewise, 6.7% of patients with ulcerative colitis had a heart attack. In contrast, the prevalence of MI was just 3.3% in persons without IBD.

The risk was highest during active flares or persistent disease, while a reduction in risk was observed, when the disease was in remission. The odds of MI in IBD patients overall were highest in younger patients and decreased with age (age 30–34 years: OR 12.05 [11.16–13.01], age 65+ years: OR 2.08 [2.04–2.11]), which means that IBD patients aged 30 to 34 years were 12 times more likely to have a heart attack than their counterparts; IBD patients aged 65 years only about twice as likely to have MI as persons without IBD.

The inflammatory process in IBD has been implicated as the factor that predisposes these patients to develop a heart attack. The chronic inflammation promotes clot formation, which may block the coronary arteries and incite an acute heart event.

These findings suggest that IBD may be an independent risk factor for heart disease and emphasize the need for aggressive risk factor reduction in these patients.

IBD patients should be closely watched for risk factors for heart disease such as hypertension, diabetes, smoking, obesity, high cholesterol.

Since the risk was found to be low when the disease was in remission, keeping IBD under control as well as modifying risk factors can reduce the risk of heart attack in these patients.

(Source: Panhwar MS, et al. Risk of myocardial infarction in inflammatory bowel disease: a population-based national study. Inflamm Bowel Dis. 2018 Nov 30. doi: 10.1093/ibd/izy354)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA