Department of Medicine, University of Miami/Miller School of Medicine, Miami, FL, USA.
Am J Gastroenterol. 2011 Apr;106(4):741-7. doi: 10.1038/ajg.2011.63. Epub 2011 Mar 8.
Patients with inflammatory bowel disease (IBD) present with several extraintestinal manifestations, including systemic inflammation and hypercoagulability. Limited studies have shown that patients with IBD may have a higher risk of developing atherosclerosis. The incidence of coronary artery disease (CAD) and the role of traditional CAD risk factors in IBD patients remain unclear. We sought to compare the rates of CAD events in patients with IBD with matched controls.
We performed a longitudinal cohort study of patients with IBD compared with matched controls. The primary outcome was the development of CAD events. Traditional and nontraditional CAD risk factors were assessed. Cox proportional hazards model was used to assess the impact of each CAD risk factor on the outcomes.
A total of 356 IBD patients and 712 matched controls were followed for a median of 53 and 51 months, respectively. The unadjusted hazard ratio (HR) for developing CAD in the IBD group was 2.85 (95% confidence interval (CI) 1.82-4.46). IBD patients had significantly lower rates of selected traditional CAD risk factors (hypertension, diabetes, dyslipidemia, and obesity; P<0.01 for all). Adjusting for these factors, the HR for developing CAD between groups was 4.08 (95% CI 2.49-6.70). Among nontraditional risk factors, an elevated white blood cell (WBC) count was a risk factor for CAD development in the IBD group (HR 1.23; 95% CI 1.15-1.33).
An increased incidence of CAD events was noted in IBD patients despite having a lower burden of traditional risk factors. Additionally, these risk factors had a lower impact on CAD development in the IBD group. Further investigation into how nontraditional risk factors, including WBC count, and the effect of attenuating systemic inflammation in IBD patients change CAD risk is warranted.
炎症性肠病（IBD）患者存在多种肠外表现，包括全身炎症和高凝状态。有限的研究表明，IBD 患者可能有更高的患动脉粥样硬化风险。冠心病（CAD）的发病率和传统 CAD 危险因素在 IBD 患者中的作用尚不清楚。我们旨在比较 IBD 患者和匹配对照者的 CAD 事件发生率。
我们对 IBD 患者和匹配对照者进行了一项纵向队列研究。主要结局是 CAD 事件的发生。评估了传统和非传统 CAD 危险因素。使用 Cox 比例风险模型评估每个 CAD 危险因素对结局的影响。
共纳入 356 例 IBD 患者和 712 例匹配对照者，中位随访时间分别为 53 个月和 51 个月。校正混杂因素后，IBD 组发生 CAD 的风险比（HR）为 2.85（95%可信区间 1.82-4.46）。IBD 患者的某些传统 CAD 危险因素（高血压、糖尿病、血脂异常和肥胖）的发生率显著降低（所有 P<0.01）。校正这些因素后，两组间发生 CAD 的 HR 为 4.08（95%可信区间 2.49-6.70）。在非传统危险因素中，白细胞（WBC）计数升高是 IBD 组 CAD 发生的危险因素（HR 1.23；95%可信区间 1.15-1.33）。
尽管 IBD 患者的传统危险因素负担较低，但 CAD 事件的发生率仍较高。此外，这些危险因素对 IBD 组 CAD 发生的影响较小。进一步研究非传统危险因素（包括 WBC 计数）以及减轻 IBD 患者全身炎症对 CAD 风险的影响是有必要的。
