Abstract
Background
As a chronic systemic inflammation may be associated with an increased risk of vascular
events, the aim of the present study was to assess the incidence of stroke and transient
ischemic attack (TIA) in patients with inflammatory bowel disease over a period of
15 years.
Methods
This cohort study included patients for whom the initial diagnosis of an inflammatory
bowel disease (IBD) (Crohn's disease: CD and ulcerative colitis: UC) was documented
anonymously between 2000 and 2015 in 1,262 general practices in Germany. IBD patients
were matched to patients without IBD using propensity scores based on age, sex, physician,
co-diagnoses and co-therapies. Cox regression models were used to study the incidence
of stroke and TIA as a function of CD and UC.
Results
Each of the matched groups included 11,947 participants. In the IBD group, 43.5% had
CD and 56.5% UC respectively. Higher incidences of both stroke and TIA were detected
for IBD (stroke: 279.0 versus 222.6 cases per 100,000 patient years, HR 1.30, p=0.011;
TIA: 203.1 versus 141.1 cases per 100,000 patient years, HR 1.42, p=0.006). Stroke
and TIA incidences (cases per 100,000 patient years) were higher than in controls
(stroke: 314.7 versus 204.5, HR: 1.50, p=0.013; TIA: 183.8 versus 95.3, HR: 1.93,
p=0.004) in CD patients only. No relevant differences in incidences were found for
patients with UC.
Conclusion
While CD turned out to be a relevant precondition for stroke or TIA, this was not
the case for UC.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Inflammation, atherosclerosis, and coronary artery disease.N Engl J Med. 2005; 352: 1685-1695
- Venous thromboembolism and atherothrombosis: an integrated approach.Circulation. 2010; 121: 2146-2150
- Patients with inflammatory bowel disease have an increased risk of myocardial infarction: a nationwide study.Aliment Pharmacol Ther. 2019; 50: 769-779
- Inflammatory bowel disease and the risk for cardiovascular disease: does all inflammation lead to heart disease?.Trends Cardiovasc Med. 2019; : 10
- Risk of cardiovascular disease in inflammatory bowel disease.Exp Ther Med. 2017; 13: 395-400
- Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study.Europace. 2014; 16: 477-484
- Disease activity in inflammatory bowel disease is associated with arterial vascular disease.Inflamm Bowel Dis. 2020; : izaa156
- Risk of cerebrovascular accidents and ischemic heart disease in patients with inflammatory bowel disease: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2014; 12: 382-393
- Risk of stroke in patients with inflammatory bowel disease: a systematic review and meta-analysis.J Stroke Cerebrovasc Dis. 2015; 24: 2774-2780
- Inflammatory bowel disease and risk of stroke: a meta-analysis of cohort studies.Int J Cardiol. 2016; 202: 106-109https://doi.org/10.1016/j.ijcard.2015.08.190
- The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study.Clin Gastroenterol Hepatol. 2008; 6: 41-45
- Basic characteristics and representativeness of the German Disease Analyzer database.Int J Clin Pharmacol Ther. 2018; 56: 459-466
- Diagnostic problems and advances in inflammatory bowel disease.Mod Pathol. 2003; 16: 347-358
- High-sensitivity C-reactive protein and interleukin-6-dominant inflammation and ischemic stroke risk: the northern Manhattan study.Stroke. 2014; 45: 979-987
- Disease activity in inflammatory bowel disease is associated with arterial vascular disease.Inflamm Bowel Dis. 2020; : izaa156
- Acute cerebrovascular disease in the young: the stroke in Young Fabry patients study.Stroke. 2013; 44: 340-349
- Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry patients study.Stroke. 2013; 44: 119-125
- Lessons from everyday stroke care for clinical research and vice versa: comparison of a comprehensive and a research population of young stroke patients.BMC Neurol. 2014; 14: 45https://doi.org/10.1186/1471-2377-14-45
- Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease.Am J Gastroenterol. 2009; 104: 371-383
- Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study.Lancet. 2010; 375: 657-663
- Women and ischemic heart disease: evolving knowledge.J Am Coll Cardiol. 2009; 54: 1561-1575
- Oral contraceptives and ischemic stroke risk.Stroke. 2018; 49: e157-e159
- Temporal trends of sex differences in transient ischemic attack incidence within a population.J Stroke Cerebrovasc Dis. 2019; 28: 2468-2474
- Gender differences in the social functioning of adolescents with inflammatory bowel disease.J Clin Psychol Med Settings. 2012; 19: 270-276
Article info
Publication history
Published online: April 14, 2021
Accepted:
March 23,
2021
Received in revised form:
March 2,
2021
Received:
December 9,
2020
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105787
Copyright
© 2021 Elsevier Inc. All rights reserved.
