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.
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.
Am J Med. 2021 Aug;134(8):1047-1051.e2. doi: 10.1016/j.amjmed.2021.02.029. Epub 2021 Apr 1.
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.
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.
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).
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.
最近的文献表明，动脉粥样硬化性心血管疾病与炎症性肠病之间存在关联，这种关联可能通过慢性炎症途径介导。然而，在患有早发性动脉粥样硬化性心血管疾病的年轻患者中，证明这种关系的数据很少。
我们使用全国退伍军人早发动脉粥样硬化（VITAL）登记处的数据，评估了极早发和早发动脉粥样硬化性心血管疾病（诊断年龄：分别≤40 岁和≤55 岁）与炎症性肠病之间的关系。将患者与无动脉粥样硬化性心血管疾病的年龄匹配对照组进行比较。多变量回归模型调整了传统的危险因素。
我们确定了 147600 名患者和 9485 名患有早发性和极早发性动脉粥样硬化性心血管疾病的患者。与对照组相比，早发性（0.96%比 0.84%；优势比[OR]1.14；95%置信区间[CI]，1.08-1.21）和极早发性（1.36%比 0.75%；OR 1.82；95% CI，1.52-2.17）患者中总体炎症性肠病的患病率更高。调整后，这两种关联在早发性和极早发性组均减弱（OR 1.07；95% CI，1.00-1.14 和 OR 1.61；95% CI，1.34-1.94）。
炎症性肠病与极早发性动脉粥样硬化性心血管疾病的发生风险较高相关，尤其是年龄≤40 岁的患者。随着年龄的增长，肥胖、高血压、糖尿病、吸烟和血脂异常等传统心血管代谢因素会减弱这种风险。需要前瞻性研究来评估早期干预对降低炎症性肠病年轻患者心血管风险的作用。
