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Premature Atherosclerotic Cardiovascular Disease Risk Among Patients with Inflammatory Bowel Disease

  • Author Footnotes
    1 These authors contributed equally to this work.
    Michelle T. Lee
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas

    Section of Health Services Research, Department of Medicine
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Dhruv Mahtta
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas

    Section of Health Services Research, Department of Medicine

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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  • Liang Chen
    Affiliations
    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas

    Section of Health Services Research, Department of Medicine
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  • Aliza Hussain
    Affiliations
    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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  • Mahmoud Al Rifai
    Affiliations
    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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  • Preetika Sinh
    Affiliations
    Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee
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  • Umair Khalid
    Affiliations
    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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  • Khurram Nasir
    Affiliations
    Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Texas
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  • Christie M. Ballantyne
    Affiliations
    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
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  • Laura A. Petersen
    Affiliations
    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas

    Section of Health Services Research, Department of Medicine
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  • Salim S. Virani
    Correspondence
    Requests for reprints should be addressed to Salim S. Virani, MD, PhD, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030.
    Affiliations
    Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, Houston, Texas

    Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas

    Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Abstract

      Background

      Recent literature has shown an association between atherosclerotic cardiovascular disease and inflammatory bowel disease, potentially mediated through chronic inflammatory pathways. However, there is a paucity of data demonstrating this relationship among young patients with premature atherosclerotic cardiovascular disease.

      Methods

      Using data from the nationwide Veterans wIth premaTure AtheroscLerosis (VITAL) registry, we assessed the association between extremely premature and premature atherosclerotic cardiovascular disease (age at diagnosis: ≤40 years and ≤55 years, respectively) and inflammatory bowel disease. Patients were compared with age-matched controls without atherosclerotic cardiovascular disease. Multivariable regression models adjusted for traditional risk factors.

      Results

      We identified 147,600 patients and 9485 patients with premature and extremely premature atherosclerotic cardiovascular disease, respectively. Compared with controls, there was a higher prevalence of overall inflammatory bowel disease among premature (0.96% vs 0.84%; odds ratio [OR] 1.14; 95% confidence interval [CI], 1.08-1.21) and extremely premature (1.36% vs 0.75%; OR 1.82; 95% CI, 1.52-2.17) patients. After adjustment, these associations attenuated in both premature and extremely premature groups (OR 1.07; 95% CI, 1.00-1.14 and OR 1.61; 95% CI, 1.34-1.94, respectively).

      Conclusion

      Inflammatory bowel disease is associated with higher odds of extremely premature atherosclerotic cardiovascular disease, especially for those age ≤40 years. With increasing age, this risk is attenuated by traditional cardiometabolic factors such as obesity, hypertension, diabetes, smoking, and dyslipidemia. Prospective studies are needed to assess the role of early intervention to decrease cardiovascular risk among young patients with inflammatory bowel disease.

      Keywords

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