Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Eur Heart J. 2024 Jul 21;45(28):2493-2504. doi: 10.1093/eurheartj/ehae338.
Dysregulation of inflammatory and immune responses has been implicated in the pathogenesis of heart failure (HF). But even if inflammation is a prerequisite for inflammatory bowel disease (IBD), little is known about HF risk in IBD.
In this Swedish nationwide cohort, patients with biopsy-confirmed IBD were identified between 1969 and 2017 [n = 81 749, Crohn's disease (CD, n = 24 303), ulcerative colitis (UC, n = 45 709), and IBD-unclassified (IBD-U, n = 11 737)]. Each patient was matched with up to five general population reference individuals (n = 382 190) and IBD-free full siblings (n = 95 239) and followed until 31 December 2019. Flexible parametric survival models estimated the adjusted hazard ratio (aHR) and standardized cumulative incidence for HF, with 95% confidence intervals (CI).
There were 5582 incident HF identified in IBD patients (incidence rate [IR]: 50.3/10 000 person-years) and 20 343 in reference individuals (IR: 37.9) during a median follow-up of 12.4 years. IBD patients had a higher risk of HF than reference individuals (aHR 1.19, 95% CI 1.15-1.23). This increased risk remained significant ≥20 years after IBD diagnosis, leading to one extra HF case per 130 IBD patients until then. The increased risk was also observed across IBD subtypes: CD (IR: 46.9 vs. 34.4; aHR 1.28 [1.20-1.36]), UC (IR: 50.1 vs. 39.7; aHR 1.14 [1.09-1.19]), and IBD-U (IR: 60.9 vs. 39.0; aHR 1.28 [1.16-1.42]). Sibling-controlled analyses showed slightly attenuated association (IBD: aHR 1.10 [1.03-1.19]).
Patients with IBD had a moderately higher risk of developing HF for ≥20 years after IBD diagnosis than the general population.
炎症和免疫反应失调与心力衰竭（HF）的发病机制有关。但是，即使炎症是炎症性肠病（IBD）的前提，人们对 IBD 患者 HF 的风险也知之甚少。
在这项瑞典全国性队列研究中，于 1969 年至 2017 年间确诊为 IBD 的患者（n=81749，克罗恩病[CD]患者 24303 例，溃疡性结肠炎[UC]患者 45709 例，IBD 未分类[IBD-U]患者 11737 例）被识别出来。每位患者均与最多 5 名普通人群参考个体（n=382190）和 IBD 无家族史的同胞（n=95239）相匹配，并随访至 2019 年 12 月 31 日。灵活参数生存模型估计了 HF 的调整后的危险比（aHR）和标准化累积发病率，置信区间（CI）为 95%。
在中位随访 12.4 年后，在 IBD 患者中发现了 5582 例 HF（发病率[IR]：50.3/10000 人年），在参考个体中发现了 20343 例 HF（IR：37.9）。IBD 患者的 HF 风险高于参考个体（aHR 1.19，95%CI 1.15-1.23）。这种风险增加在 IBD 诊断后至少 20 年仍然显著，导致在此期间每 130 例 IBD 患者就会增加一例 HF。这种风险增加也见于不同的 IBD 亚型：CD（IR：46.9 比 34.4；aHR 1.28[1.20-1.36]）、UC（IR：50.1 比 39.7；aHR 1.14[1.09-1.19]）和 IBD-U（IR：60.9 比 39.0；aHR 1.28[1.16-1.42]）。同胞对照分析显示，关联略有减弱（IBD：aHR 1.10[1.03-1.19]）。
与普通人群相比，IBD 患者在 IBD 诊断后至少 20 年内发生 HF 的风险略高。
