Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40 Na-6, 3015 GD, PO Box 2040, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eur J Prev Cardiol. 2023 Oct 26;30(15):1615-1622. doi: 10.1093/eurjpc/zwad124.
Inflammatory bowel disease (IBD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). We compared cardiovascular disease (CVD) risk factors and 10-year risk in IBD patients to the general population.
In this cross-sectional study, consecutive IBD patients ≥45 years were included. History of ASCVD and CVD risk factors (smoking, hypertension, overweight, hypercholesterolaemia, diabetes, and metabolic syndrome) were assessed. The Systematic COronary Risk Evaluation (SCORE2) algorithm was used to estimate 10-year CVD risk. One to four age/sex-matched controls were derived from the prospective population-based Rotterdam Study cohort. In total, 235 IBD patients were included {56% women, median age 59 years [interquartile range (IQR) 51-66]} and matched to 829 controls [56% women, median age 61 years (IQR 56-67)]. Inflammatory bowel disease patients experienced ASCVD events more often compared with matched controls [odds ratio (OR) 2.01, 95% confidence interval (CI) 1.23-3.27], specifically heart failure (OR 2.02, 95% CI 1.02-4.01) and coronary heart disease (OR 2.01, 95% CI 1.7-3.13). Inflammatory bowel disease patients showed lower odds of overweight (OR 0.48, 95% CI 0.35-0.66) and hypercholesterolaemia (OR 0.45, 95% CI 0.31-0.65) and higher odds of hypertension (OR 1.67, 95% CI 1.19-2.32), as well as higher waist circumference (+4 cm, P = 0.006) and triglyceride levels (+0.6 mmol/L, P < 0.001) as compared with controls. Mean 10-year CVD risk was 4.0% [standard deviation (SD) ±2.6] in 135 IBD patients vs. 6.0% (SD ±1.6) in 506 controls.
The increased CVD risk in IBD is discrepant with the 10-year CVD risk estimate. Systematic COronary Risk Evaluation may underestimate CVD risk in IBD patients due to differing CVD risk profiles compared with the general population, including a lower prevalence of hypercholesterolaemia and overweight and a higher prevalence of hypertension, abdominal obesity, and hypertriglyceridaemia.
炎症性肠病（IBD）与动脉粥样硬化性心血管疾病（ASCVD）的风险增加相关。我们比较了 IBD 患者与普通人群的心血管疾病（CVD）危险因素和 10 年风险。
在这项横断面研究中，纳入了年龄≥45 岁的连续 IBD 患者。评估了 ASCVD 病史和 CVD 危险因素（吸烟、高血压、超重、高胆固醇血症、糖尿病和代谢综合征）。使用系统性冠状动脉风险评估（SCORE2）算法估计 10 年 CVD 风险。从前瞻性基于人群的鹿特丹研究队列中得出 1 至 4 个年龄/性别匹配的对照。共纳入 235 名 IBD 患者{56%为女性，中位年龄 59 岁[四分位距（IQR）51-66]}，并与 829 名对照匹配[56%为女性，中位年龄 61 岁（IQR 56-67）]。与匹配的对照组相比，IBD 患者更常发生 ASCVD 事件[比值比（OR）2.01，95%置信区间（CI）1.23-3.27]，特别是心力衰竭（OR 2.02，95%CI 1.02-4.01）和冠心病（OR 2.01，95%CI 1.7-3.13）。IBD 患者超重（OR 0.48，95%CI 0.35-0.66）和高胆固醇血症（OR 0.45，95%CI 0.31-0.65）的可能性较低，高血压（OR 1.67，95%CI 1.19-2.32）的可能性较高，腰围（+4cm，P=0.006）和甘油三酯水平（+0.6mmol/L，P<0.001）也较高与对照组相比。与 506 名对照组相比，135 名 IBD 患者的 10 年 CVD 风险平均为 4.0%（标准差（SD）±2.6）。
IBD 中增加的 CVD 风险与 10 年 CVD 风险估计不一致。由于与普通人群相比，CVD 风险状况存在差异，包括高胆固醇血症和超重的患病率较低，高血压、腹部肥胖和高三酰甘油血症的患病率较高，因此 SCORE2 可能低估了 IBD 患者的 CVD 风险。
