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The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study.

Abstract

BACKGROUND & AIMS

We aimed to determine if there was an increased risk for arterial thromboembolic diseases (ATED) in inflammatory bowel disease (IBD).

METHODS

We used the University of Manitoba IBD Epidemiology Database (1984-2003) (n = 8060), and a matched cohort (n = 80,489) drawn from the Manitoba Health administrative database. Each IBD case and non-IBD control has a unique personal health identification number and each health system encounter is identified by a diagnostic code (International Classification of Diseases, 9th revision [ICD-9]). We compared the IBD with the non-IBD cohorts for the incidence of ATED events following the index case diagnosis of IBD including: ischemic heart disease (ICD-9-Clinical Modification [CM] codes 410-414.x), cerebrovascular disease (ICD-9-CM codes 430-436.x), and undifferentiated ATED (ICD-9-CM codes 440.x and 445.x). The incidence rate of 1 episode or more of these diseases was assessed in relation to the individual person-years of follow-up evaluation. Incidence rates and incidence rate ratios (IRRs) were computed for all IBD, and stratified by IBD diagnosis, sex, and age.

RESULTS

For ischemic heart disease, risk was increased for all IBD (IRR, 1.26; 95% confidence interval [CI], 1.11-1.44) and was increased for Crohn's disease and ulcerative colitis in both, males and females. For cerebrovascular disease, only Crohn's disease was associated with increased risk (IRR, 1.32; 95% CI, 1.05-1.66), and for undifferentiated ATED only females (IRR, 1.96; 95% CI, 1.24-3.10) and those aged 0 to 39 years (IRR, 19.95; 95% CI, 1.81-219.92) and 40 to 59 years (IRR, 3.17; 95% CI, 1.27-7.91) had significantly increased risks.

CONCLUSIONS

IBD patients are more likely to have cardiac ATED, regardless of diagnosis or sex. Crohn's disease has an increased risk for cerebral ATED. Smoking, the prothrombotic aspect of systemic inflammation, or a genetic predisposition may contribute to the risk.

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  • Authors+Show Affiliations

    ,

    University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada. cbernst@cc.umanitoba.ca

    ,

    Source

    MeSH

    Adolescent
    Adult
    Age Factors
    Arterial Occlusive Diseases
    Case-Control Studies
    Cerebrovascular Disorders
    Child
    Child, Preschool
    Cohort Studies
    Female
    Humans
    Incidence
    Infant
    Infant, Newborn
    Inflammatory Bowel Diseases
    Male
    Manitoba
    Middle Aged
    Myocardial Ischemia
    Registries
    Sex Factors
    Thromboembolism

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18063423

    Citation

    Bernstein, Charles N., et al. "The Incidence of Arterial Thromboembolic Diseases in Inflammatory Bowel Disease: a Population-based Study." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 6, no. 1, 2008, pp. 41-5.
    Bernstein CN, Wajda A, Blanchard JF. The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. Clin Gastroenterol Hepatol. 2008;6(1):41-5.
    Bernstein, C. N., Wajda, A., & Blanchard, J. F. (2008). The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 6(1), pp. 41-5.
    Bernstein CN, Wajda A, Blanchard JF. The Incidence of Arterial Thromboembolic Diseases in Inflammatory Bowel Disease: a Population-based Study. Clin Gastroenterol Hepatol. 2008;6(1):41-5. PubMed PMID: 18063423.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. AU - Bernstein,Charles N, AU - Wajda,Andre, AU - Blanchard,James F, Y1 - 2007/12/11/ PY - 2007/12/8/pubmed PY - 2008/2/26/medline PY - 2007/12/8/entrez SP - 41 EP - 5 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 6 IS - 1 N2 - BACKGROUND & AIMS: We aimed to determine if there was an increased risk for arterial thromboembolic diseases (ATED) in inflammatory bowel disease (IBD). METHODS: We used the University of Manitoba IBD Epidemiology Database (1984-2003) (n = 8060), and a matched cohort (n = 80,489) drawn from the Manitoba Health administrative database. Each IBD case and non-IBD control has a unique personal health identification number and each health system encounter is identified by a diagnostic code (International Classification of Diseases, 9th revision [ICD-9]). We compared the IBD with the non-IBD cohorts for the incidence of ATED events following the index case diagnosis of IBD including: ischemic heart disease (ICD-9-Clinical Modification [CM] codes 410-414.x), cerebrovascular disease (ICD-9-CM codes 430-436.x), and undifferentiated ATED (ICD-9-CM codes 440.x and 445.x). The incidence rate of 1 episode or more of these diseases was assessed in relation to the individual person-years of follow-up evaluation. Incidence rates and incidence rate ratios (IRRs) were computed for all IBD, and stratified by IBD diagnosis, sex, and age. RESULTS: For ischemic heart disease, risk was increased for all IBD (IRR, 1.26; 95% confidence interval [CI], 1.11-1.44) and was increased for Crohn's disease and ulcerative colitis in both, males and females. For cerebrovascular disease, only Crohn's disease was associated with increased risk (IRR, 1.32; 95% CI, 1.05-1.66), and for undifferentiated ATED only females (IRR, 1.96; 95% CI, 1.24-3.10) and those aged 0 to 39 years (IRR, 19.95; 95% CI, 1.81-219.92) and 40 to 59 years (IRR, 3.17; 95% CI, 1.27-7.91) had significantly increased risks. CONCLUSIONS: IBD patients are more likely to have cardiac ATED, regardless of diagnosis or sex. Crohn's disease has an increased risk for cerebral ATED. Smoking, the prothrombotic aspect of systemic inflammation, or a genetic predisposition may contribute to the risk. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/18063423/The_incidence_of_arterial_thromboembolic_diseases_in_inflammatory_bowel_disease:_a_population_based_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00917-2 DB - PRIME DP - Unbound Medicine ER -