IBD Treatment Linked to Lower Risk of Myocardial Infarctions

Motasem Alkhayyat, MD

While it is believed that inflammatory bowel disease (IBD) patients have an increased risk of myocardial infarctions, it is unknown whether IBD medications have an impact in increasing this risk.

A team, led by Motasem Alkhayyat, MD, Cleveland Clinic Foundation, used a large database to identify the association between IBD with myocardial infarction and the impact of IBD medications in data presented at the annual American College of Gastroenterology (ACG) 2020 conference.

The researchers used a large, multi-institutional database that included an aggregate of electronic health record data from 26 US healthcare systems surveyed.

Overall, they identified a cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of (SNIMED-CT) IBD between 2016-2020.

In addition, they identified a separate cohort of individuals who developed myocardial infarctions after at least 30 days following a IBD diagnosis.

The investigators performed a statistical analysis using Statistical Package for Social Sciences and a two-sided P value of less than 0.05 for all analyses to be considered statistically significant.

Ultimately, the team identified 39,328,760 individuals in the database, 181,670 of which had Crohn’s disease (0.46%) and 154,500 of which had ulcerative colitis (0.39%).

The prevalence of patients with a new diagnosis of myocardial infarction after at least 30 days of a Crohn’s disease or ulcerative colitis diagnosis or the general population were 8.6% , 7.0%, and 2.7% respectively (P <0.0001).

When compared to non-IBD patients, the investigators found patients with a history of IBD had a higher overall risk association of myocardial infarction (OR, 3.68; 95% CI, 3.56-3.81) for Crohn’s disease and (OR, 2.72; 95% CI, 2.66-2.77) for ulcerative colitis.

IBD patients with a history of biologicals had a significantly lower risk of developing myocardial infarctions. The authors found Crohn’s disease patients treated with infliximab (OR, 0.32; 95% CI, 0.30-0.35), adalimumab (OR, 0.34; 95% CI, 0.31-0.37), certolizumab (OR, 0.33; 95% CI 0.27-0.41), vedolizumab (OR, 0.37; 95% CI, 0.31-0.43), and ustekinumab (OR, 0.24; 95% CI 0.19-0.31) had lower risks of developing myocardial infarctions.

For ulcerative colitis, experience with infliximab (OR, 0.50; 95% CI, 0.45-0.56), adalimumab (OR, 0.52; 95% CI, 0.47-0.58), vedolizumab (OR, 0.45; 95% CI, 0.38-0.54), and ustekinumab (OR, 0.42; 95% CI,0.29-0.61) lowered the risk of developing myocardial infarctions.

In addition, patients treated with thiopurines (azathioprine [Crohn’s disease]: OR, 0.42; 95%, 0.39-0.45; 6-MP: OR, 0.37; 95% CI, 0.33-0.42) and [ulcerative colitis] OR, 0.72; 95% CI, 0.66-0.78 and OR, 0.62; 95% CI, 0.54-0.71, respectively), and 5ASAs [Crohn’s disease: OR, 0.58; 95% CI, 0.56-0.61, ulcerative colitis: OR, 0.78; 95% CI, 0.74-0.81) had a significantly lower risk of developing myocardial infarctions.

On the other hand, natalizumab and tofacitinib was linked to a non-significant lower risk of developing the condition.

“In this large database, we found a higher risk association between MI and IBD. Patients treated with anti-TNFs, vedolizumab, ustekinumab, thiopurines, or 5-ASA had lower risk of developing MI compared to those who did not receive treatment,” the authors wrote. “The inflammatory effects of IBD may be associated with cardiovascular disease and certain IBD treatments may reduce the risk of MI.”

The study, “Lower Risk of Myocardial Infarction in Inflammatory Bowel Disease Patients Receiving Medications,” was published online by ACG.