An Investigation into the Association Between Inflammatory Bowel Disease and Cardiac Arrhythmias: An Examination of the United States National Inpatient Sample Database (original) (raw)

Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study

Europace, 2013

Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD. Methods and results From Danish nationwide registries 1996-2011, we identified 24 499 patients with new-onset IBD and 236 275 age-and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent activity [IRR 2.06 (1.67-2.55)], whereas no increased AF risk was observed in remission periods [IRR 0.97 (0.88-1.08)]. Likewise increased stroke risk was exclusively found during active IBD [IRRs: 1.57 (1.27-1.93), 1.71 (1.32-2.21), and 1.04 (0.93-1.15) for flares, persistent activity, and remission, respectively]. Conclusion Active IBD is associated with increased risk of AF and stroke. These findings may be relevant to clinical practice.

Risk of Myocardial Infarction in Inflammatory Bowel Disease: A Population-based National Study

Inflammatory Bowel Diseases, 2018

Background & Objective: Chronic inflammation is linked to increased cardiovascular risk. Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and elevated pro-inflammatory markers. The association between IBD and myocardial infarction (MI) is not well understood. We sought to elucidate this risk using a large database. Methods: We reviewed data from a large commercial database (Explorys, IBM Watson) that aggregates electronic medical records from 26 nationwide health care systems. Using systemized nomenclature of medicine-clinical terms, we identified adult patients (20 to 65 years) with a diagnosis of IBD-ulcerative colitis (UC) or Crohn's disease (CD)-who had active records between August 2013 and August 2018. We then examined the risk of MI in patients with or without IBD. Results: Out of 29,090,220 patients, 131,680 (0.45%) had UC, and 158,750 (0.55%) had CD. Prevalence of MI was higher in patients with UC and CD versus non-IBD patients (UC 6.7% vs CD 8.8% vs non-IBD 3.3%, odds ratio [OR] for UC 2.09 [2.04-2.13], and CD 2.79 [2.74-2.85]. 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]). After adjusting for age, race, sex, and traditional cardiovascular risk factor, IBD conferred greater odds of MI (adjusted odds ratio [aOR] 1.25 [1.24-1.27]). Conclusion: In this large cohort, IBD is associated with significantly increased MI compared with non-IBD patients. The relative risk of MI was highest in younger patients and decreased with age. These findings emphasize the need for aggressive risk factor reduction in IBD.

Heart Rate Recovery Is Impaired In Patients with Inflammatory Bowel Diseases

Medical Principles and Practice, 2016

Mean duration of IBD was 7.8 ± 3.6 years. In addition, there was a significant negative correlation between disease duration and HRR at the first minute (r =-0.704, p < 0.001). Multivariate logistic regression analysis showed that symptom duration (OR: 1.742, 95% CI: 1.148-2.636, p = 0.009) was an independent predictor of impaired HRR in patients with IBD. Conclusion: In this study, the data showed that the HRR was impaired in patients with IBDs. Hence, given the prognostic value of the test, patients with IBD should be monitored for future cardiovascular events.

Heart rate variability and inflammatory bowel disease in humans

Medicine, 2020

The autonomic nervous system (ANS) maintains homeostasis in the gastrointestinal tract, including immunity, inflammation and motility, through the brain-gut axis. To date, the associations between ANS function and inflammatory bowel disease (IBD) have been controversial and inconclusive in human studies. PubMed, Cochrane Library, and Embase were searched through February 2020 for articles reporting these association between heart rate variability (HRV), an indirect measure of ANS activity, and IBD. The standardized mean differences and 95% confidence intervals (CIs) were calculated. Ten eligible studies involving 273 ulcerative colitis patients, 167 Crohn's disease patients and 208 healthy controls were included. The values of the total power (SMD = À0.83, 95% CI = À1.44, À0.21), high frequency (SMD = À0.79, 95% CI = À1.20, À0.38), RR interval (SMD = À0.66, 95% CI = À1.04, À0.27), standard deviation of the RR intervals (SMD = À1.00, 95% CI = À1.73, À0.27), percentage of RR intervals with a greater than 50-millisecond variation (SMD = À 0.82, 95% CI = À1.33, À0.30) and the square root of the mean squared differences in successive RR intervals (SMD = À0.71, 95% CI = À1.15, À0.26) of the IBD patients were lower than those of the healthy controls, and moderate to large effect sizes were observed in all HRV indices, except for low frequency (SMD = À0.41, 95% CI = 0.95, 0.13). IBD was strongly associated with an overall decrease in HRV, indicating substantially decreased ANS activity. Furthermore, the parasympathetic nerve displayed a stronger inverse association with ANS activity than the sympathetic nerve, indicating ANS dysfunction in patients with IBD. Abbreviations: ANS = autonomic nervous system, BMI = body mass index, CD = Crohn's disease, CIs = confidence intervals, HF = high frequency, HRV = between heart rate variability, IBD = inflammatory bowel disease, IL = interleukin, IRB = Institutional Review Board, LF = low frequency, pNN50 = percentage of RR intervals with a greater than 50-millisecond variation, RMSSD = square root of the mean squared differences of successive RR intervals, SDNN = standard deviation of the RR intervals, SDs = standard deviations, SMDs = standardized mean differences, TNF = tumor necrosis factor, TP = total power, UC = ulcerative colitis.

THE RELATIONSHIP BETWEEN INFLAMMATORY BOWEL DISEASE, CARDIOVASCULAR RISK FACTORS, AND OUTCOMES: AN UMBRELLA REVIEW

Background: Inflammatory bowel disease (IBD) affects nearly 5 million individuals worldwide, with increasing incidence and prevalence over the past few decades. Emerging evidence suggests an association between IBD, and cardiovascular diseases (CVD), potentially due to shared inflammatory pathways and immune-mediated mechanisms. However, existing systematic reviews and meta-analyses investigating this association have yielded inconsistent results. We conducted an umbrella review to systematically assess and synthesize the available evidence on the relationship between IBD and cardiovascular factors. Methods: We adhered to the PRISMA Statement 2020 guidelines and performed a comprehensive literature search in PubMed, Web of Science, and Scopus. We included systematic reviews and meta-analyses published in peer-reviewed journals that investigated the association between IBD, cardiovascular risk factors, and CVD. Data extraction was performed using a standardized form, and we conducted a narrative synthesis of the included studies, focusing on the associations between IBD, cardiovascular risk factors and outcomes. Results: Our search identified nine studies, which reported an increased risk of adverse cardiovascular outcomes, including myocardial infarction, stroke, heart failure, and thrombotic events among IBD patients compared to non-IBD controls. IBD patients demonstrated increased arterial stiffness and endothelial dysfunction. However, the primary studies within these reviews were mainly observational. The JBI appraisal scores of the included studies ranged from 4 to 9; the majority of the included studies had high or moderate JBI Appraisal Scores, suggesting that the overall quality of the evidence was relatively good. The findings from these studies were more likely to be reliable and can be used to inform evidence-based decision-making in healthcare. However, the lower-quality study (score: 4) should be carefully considered and corroborated with additional research before drawing any strong conclusions. Conclusion: This umbrella review provides strong evidence for an association between IBD and increased cardiovascular risk/associated CVD outcomes. Further research is needed to elucidate the underlying mechanisms, identify potential risk factors, and develop effective prevention and management strategies for IBD patients. Future studies should investigate the role of IBD treatments, disease duration, and severity on cardiovascular outcomes, as well as explore the potential interactions between IBD and other cardiovascular risk factors.

Impact of Atrial Fibrillation on Patients With Inflammatory Bowel Disease Admitted for Colectomy

Cureus

Introduction Inflammatory bowel disease (IBD) is a chronic, relapsing, inflammatory disorder of the gastrointestinal tract. Patients with IBD may undergo a segmental or total colectomy, depending upon the extent of the disease. It is estimated that approximately 20 to 30 percent of patients with advanced ulcerative colitis will eventually require surgical resection. The incidence and prevalence of Atrial Fibrillation (AF) are increasing globally. There is plausible evidence linking inflammation to the initiation and perpetuation of AF. Given the importance of systemic inflammation in the pathogenesis of AF, an increased risk of the development of other diseases related to systemic inflammation can be expected. Objective Study how AF can affect the outcome of the patients in a population database hospitalized due to IBD flare and in whom colectomy was performed. Methodology Data from the National Inpatient Sample database from 2016 to 2019 were used to obtain baseline demographic numbers and outcome variables. T-tests and chi-square tests were used to compare data. Univariate and multivariate logistic regression was used to calculate Odds ratios for comorbidities. Results The study identified 27,165 patients with IBD who had colectomy during the same admission, among whom 2,045 also had AF. AF patients had a statistically significant longer mean LOS than patients without AF (16.79 vs. 11.24 days, p-value 0.001). AF patients also had significantly higher hospital charges ($222,109 vs. $142,011, p-value < 0.001). The mortality rate in IBD undergoing colectomy patients with AF was higher than in patients without AF (13.45% vs. 2.69%, p-value < 0.001), which was also reflected in multivariate analysis with an odds ratio of 2.27 (p-value < 0.001) after adjusting for age, gender, race, and comorbidities. Conclusion Our study showed that a national cohort of IBD patients with a history of colectomy had increased mortality and morbidity in the presence of AF. A finding that can guide physicians to allocate more time to optimizing the management of AF in this group of patients decreases the risk of complications, length of stay, and overall mortality.

Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity

Circulation: Cardiovascular Quality and Outcomes, 2014

Background— Inflammatory bowel disease (IBD) is associated with increased cardiovascular risk. We examined the effect of active IBD on major adverse cardiovascular outcomes after myocardial infarction (MI). Methods and Results— In nationwide registries, we identified 86 790 patients with first-time MI from the period 2002 to 2011. A total of 1030 patients had IBD, and we categorized their disease activity stages into either flare (120 days), persistent (>120 days) activity, or remission. Short-term mortality was estimated in a logistic regression-model, whereas risk of recurrent MI, all-cause mortality, and a composite of recurrent MI, cardiovascular death, and stroke were estimated by Cox regression-models. Odds ratio of death during hospitalization or within 30 days of discharge (n=13 339) corresponded to 3.29 (95% confidence interval [CI], 1.98–5.45) for patients in IBD flares, 1.62 (95% CI, 0.95–2.77) for persistent activity, and 0.97 (95% CI, 0.78–1.19) for remission when co...

Cardiovascular Manifestations of Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Preventive Strategies

Gastroenterology Research and Practice

Inflammatory bowel disease (IBD) refers to a group of chronic inflammatory diseases that targets mainly the gastrointestinal tract. The clinical presentation of IBD includes both gastrointestinal manifestations and extraintestinal manifestations (EIM). The reported cardiovascular manifestations in IBD patients include pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, atrioventricular block, heart failure, endocarditis, valvulopathies, and Takayasu arteritis. The aim of this article is to review the available literature about the possible pathogenic mechanisms and determine preventive measures capable of reducing the incidence and severity of the cardiovascular manifestations. In IBD patients, the incidence of cardiovascular manifestations is low, but higher than that in the general population. Therefore, clinicians should pay attention to any new modification that might indicate cardiovascular involvement in IBD patients, and they should consider chronic i...