Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Clin Gastroenterol Hepatol. 2014 Oct;12(10):1695-701.e1. doi: 10.1016/j.cgh.2013.11.026. Epub 2013 Dec 4.
BACKGROUND & AIMS: Diverticular disease and cardiovascular disease share several risk factors. Inflammation associated with diverticular disease could predispose to cardiovascular disease. We assessed the association between a diagnosis of diverticular disease and subsequent arterial and venous thromboembolic events, adjusting for related comorbidities to explore a possible causal relationship.
We identified 77,065 incident cases of diverticular disease from 1980-2011 from Danish nationwide medical registries; these were matched for age and sex with 302,572 population comparison cohort members. Individuals with a history of cardiovascular disease were excluded. We used Cox proportional hazards regression to compute incidence rate ratios, comparing the incidence of acute myocardial infarction, stroke, venous thromboembolism, and subarachnoid hemorrhage in patients with diverticular disease with those of the population cohort members, adjusting for age, sex, obesity, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, connective tissue disease, renal disease, and treatments and medications.
The adjusted incidence rate ratios for patients with diverticular disease, compared with population cohort members, were 1.11 (95% confidence interval [CI], 1.07-1.14) for acute myocardial infarction, 1.11 (95% CI, 1.08-1.15) for overall stroke, 1.36 (95% CI, 1.30-1.43) for overall venous thromboembolism, and 1.27 (95% CI, 1.09-1.48) for subarachnoid hemorrhage. The relative risk of each event remained increased after we adjusted for changes in aspirin use or for endoscopy or colorectal surgery after the diagnosis of diverticular disease. These findings also held after excluding the first year of follow-up and limiting the analysis to patients with diverticulitis.
On the basis of an analysis of Danish medical registries, a diagnosis of diverticular disease is associated with a modest increase in risk of arterial and venous thromboembolic events after adjustment for related disorders.
憩室病和心血管疾病有一些共同的危险因素。与憩室病相关的炎症可能使心血管疾病易患。我们评估了憩室病的诊断与随后的动脉和静脉血栓栓塞事件之间的关系，调整了相关的合并症，以探索可能的因果关系。
我们从 1980 年至 2011 年从丹麦全国性的医疗登记处确定了 77065 例憩室病的发病病例；这些病例与 302572 名人群对照队列成员按年龄和性别进行了匹配。排除有心血管疾病病史的个体。我们使用 Cox 比例风险回归计算发病率比，比较憩室病患者与人群队列成员中急性心肌梗死、中风、静脉血栓栓塞和蛛网膜下腔出血的发生率，调整了年龄、性别、肥胖、糖尿病、血脂异常、慢性阻塞性肺疾病、结缔组织疾病、肾脏疾病以及治疗和药物。
与人群队列成员相比，患有憩室病的患者的调整发病率比为 1.11（95%置信区间[CI]，1.07-1.14）急性心肌梗死，1.11（95%CI，1.08-1.15）总中风，1.36（95%CI，1.30-1.43）总静脉血栓栓塞，1.27（95%CI，1.09-1.48）蛛网膜下腔出血。在调整阿司匹林使用变化或在诊断憩室病后进行内镜或结直肠手术后，每种事件的相对风险仍然增加。在排除随访的第一年并将分析限制在憩室炎患者后，这些发现仍然成立。
基于对丹麦医疗登记处的分析，在调整相关疾病后，憩室病的诊断与动脉和静脉血栓栓塞事件风险的适度增加相关。
