Coronary artery disease may develop at a younger age in patients with inflammatory bowel disease, even when they have fewer traditional risk factors for heart problems.
A database review of patients with CAD has determined that those with IBD were significantly younger, less heavy, and less likely to smoke than matched controls, Dr. Ashish Aggarwal and his colleagues reported in the August issue of Inflammatory Bowel Diseases (Inflamm. Bowel Dis. 2014;20:1593-601).
"These findings support the theory that traditional risk factors may not be sufficient to predict the risk of coronary artery disease in patients with IBD, and that inflammation may play a key role in the pathogenesis of atherosclerosis," wrote Dr. Aggarwal of the Cleveland Clinic and his coauthors.
The team reviewed both CAD risk factors and the outcomes of percutaneous interventions in a group of 655 patients with CAD: 131 of these had an IBD, including 54 with Crohn’s and 77 with ulcerative colitis.
The most common phenotypes among those with Crohn’s were ileocolonic disease location (39%) and nonstricturing, nonpenetrating disease (48%). Among patients with ulcerative colitis, half had extensive or pancolitis. About two-thirds of those with IBD had taken steroids at some point.
Patients with IBD were significantly younger than the control patients (65 vs. 68 years). They were also less likely to be smokers (11% vs. 19%), and had a lower mean body mass index (28 vs. 29.4 kg/m2).
However, there were no significant between-group differences in hypertension, diabetes, or hyperlipidemia. Platelet counts were similar, as were C-reactive protein levels.
The mean Framingham risk scores were 7.3 for those with IBD and 7.7 for those without – not a significant difference.
Despite their similarities in Framingham risk, the IBD patients were significantly less likely to have severe left anterior descending (LAD) disease (56% vs. 73%). They were also less likely – though not significantly so – to have multivessel disease (71% vs. 79%) and had fewer involved vessels (two vs. three).
Percutaneous coronary intervention was necessary for 28% of those with IBD and 35% of those without. Again, IBD patients were younger, had lower BMI, and were less often smokers.
The overall PCI success rate was similar, but patients with IBD were half as likely to have a major cardiac adverse event (13% vs. 24%) or die during follow-up (6.5% vs. 13.4%) – although again, these differences did not reach significance (P = .28).
Two patients with IBD and 16 without needed a repeat revascularization. IBD exercised no significant increase in the risk of any post-PCI major cardiovascular outcome.
The authors suggested that anti-inflammatory drugs based on salicylic acid compounds may offer IBD patients some cardioprotection – an idea supported by a large Danish cohort study (PLoS One 2013;8:e56944). It concluded that CAD incidence was significantly lower among those who took salicylic-based medications (relative risks, 1.16 vs. 1.36).
"Furthermore, patients with IBD were less likely to be active smokers or obese as found in our study, which again could lower the risk for future cardiovascular events," they added.
The authors had no financial disclosures; the study sponsor was not indicated.