IBD Linked to Increased Risk of Cerebrovascular Accidents

Kaichun Wu, MD, PhD

Credit: World Gastroenterology Organisation

Patients with inflammatory bowel disease (IBD) may be at a greater risk of cerebrovascular accidents, according to findings from a systematic review and meta-analysis.

Results of the study, which included a pooled population of more than 350,000 patients with IBD, suggest the pooled incidence rate of cerebrovascular accidents in patients with IBD was 2.74 per 1000 person-years, further identifying age, type of IBD, flares, and periods of chronic activity as risk factors.¹

According to the World Health Organization, 15 million people worldwide suffer from cerebrovascular accidents, also known as strokes. Hypertension, dyslipidemia, heart disease, diabetes, and obesity are common risk factors.^2,3 As many as 3 million people in the US have some form of IBD. The chronic intestinal inflammation associated with IBD has led many to question its role in exacerbating cerebrovascular accidents among affected individuals.⁴

“It is important to identify the IBD-related risk factors associated with [cerebrovascular accidents] for risk stratification and consequential management of the patients with IBD,” wrote investigators.¹ “Active intervention to prevent the occurrence of [cerebrovascular accidents] might be needed in IBD patients with a high risk of [cerebrovascular accidents].”

To estimate the incidence rate and identify risk factors for cerebrovascular accidents in patients with IBD, Kaichun Wu, MD, PhD, deputy chair of Xijing Hospital of Digestive Diseases at the Fourth Military Medical University in China, and a team of investigators searched “cerebrovascular disorders,” “cerebrovascular disease,” “stroke,” “transient ischemic attack,” “brain infarction,” and key terms for “inflammatory bowel diseases” on PubMed, Embase, and Web of Science databases for literature published through January 13, 2023. For inclusion, studies were required to be a case-control or cohort study, report the total person-years or incidence rate of cerebrovascular accidents, and specify the number of patients with ulcerative colitis (UC), Crohn disease (CD), or IBD who developed cerebrovascular accidents after diagnosis.¹

Investigators identified 4825 studies from the initial search and narrowed their selection to 93 articles for full-text analysis after removing duplicates and screening the titles and abstracts. A further 83 articles were excluded due to lack of data available for calculating the incidence of cerebrovascular accidents. In total, 10 studies including 369,956 patients with IBD were included.¹

The selected studies were published between 2008 and 2022 and were mostly population-based cohort studies, with the exception of 1 health claims database-based cohort study and 1 population-based nested case-control study. Patient populations ranged from 5,000 to 210,000.¹

The primary outcome of interest was the incidence rate of cerebrovascular accidents in patients with IBD. The secondary outcomes were the incidence rate ratio of cerebrovascular accidents in patients with IBD versus non-IBD controls and the risk factors associated with developing cerebrovascular accidents in patients with IBD.¹

Upon analysis, the pooled incidence rate of cerebrovascular accidents was 2.74 (95% confidence interval [CI], 1.83-4.10; I2 = 99.2% heterogeneity; P < .0001) per 1000 person-years in patients with IBD. Among patients with UC and CD, the pooled incidence rate was 2.85 (95% CI, 1.68-4.83; I2 = 98.7% heterogeneity; P < .0001) and 2.32 (95% CI, 1.41-3.81; I2 = 98.7% heterogeneity; P < .0001) per 1000 person-years, respectively.¹

When compared with the controls, the pooled incidence rate ratio was 1.21 (95% CI 1.09-1.34; I2 = 84.8% heterogeneity; P < .0001, P = .0002) in patients with IBD. Similarly, the incidence rates of cerebrovascular accidents in patients with UC (incidence rate ratio [IRR], 1.23; 95% CI, 1.10-1.37; I2 = 79.4% heterogeneity; P < .0001, P = .0003) and CD (IRR, 1.12; 95% CI, 1.02-1.23; I2 = 70.5% heterogeneity; P = .0013, P = .0225) were greater than the control groups.¹

Investigators identified the following risk factors for cerebrovascular accidents in patients with IBD:

• Age ≥ 40 years (RR, 7.62; 95% CI, 3.12-18.61; I2 = 94.0% heterogeneity; P < .01, P < .0001)
• Type of IBD (IRR, 1.21; 95% CI, 1.00-1.47; I2 = 81.9%; P = .0499)
• Flares (IRR, 1.70; 95% CI, 1.36-2.12; I2 = 28.7%; P < .0001)
• Periods of chronic disease activity (IRR, 2.20; 95% CI, 1.38-3.52; I2 = 83.0%; P = .0010)

“The high incidence of [cerebrovascular accidents] and the IBD-related risk factors may change the clinical practice in the management of IBD patients with a high risk of [cerebrovascular accidents],” concluded investigators.¹

References:

1. Wan J, Wang X, Zhang Y, et al. Incidence and Disease-Related Risk Factors for Cerebrovascular Accidents in Patients with Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis [published online ahead of print, 2023 Oct 5]. J Dig Dis. 2023;10.1111/1751-2980.13232. doi:10.1111/1751-2980.13232
2. World Health Organization. Stroke, Cerebrovascular accident. Health Topics. Accessed October 16, 2023. https://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html
3. Centers for Disease Control and Prevention. Know Your Risk for Stroke. Stroke. May 4, 2023. Accessed October 16, 2023. https://www.cdc.gov/stroke/risk_factors.htm
4. Cleveland Clinic. Inflammatory Bowel Disease (Overview). Diseases & Conditions. Accessed October 16, 2023. https://my.clevelandclinic.org/health/diseases/15587-inflammatory-bowel-disease-overview