The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National Study

Sara Ghoneim; Aun Shah; Aneesh Dhorepatil; Muhammad Umer Butt; Nisheet Waghray

doi:10.2147/CEG.S250182

The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National Study

Clin Exp Gastroenterol. 2020 May 4:13:123-129. doi: 10.2147/CEG.S250182. eCollection 2020.

Authors

Sara Ghoneim¹, Aun Shah¹, Aneesh Dhorepatil¹, Muhammad Umer Butt², Nisheet Waghray³

Affiliations

¹ Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA.
² Division of Cardiology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA.
³ Division of Gastroenterology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA.

Abstract

Background: Inflammatory bowel disease (IBD) has been associated with an increased risk of cardiovascular events, but the risk of cerebrovascular accidents (CVA) remains unknown. Hypercoagulability and systemic inflammation are two proposed mechanisms by which the presence of IBD might lead to the development of CVA.

Objective: To assess the risk of CVA in patients with IBD compared to those without IBD with known traditional risk factors for CVA.

Methods: We reviewed data from a large commercial database (Explorys, IBM) that aggregated records from 26 health-care systems nationwide. Using systemized nomenclature of medicine - clinical terms, we identified adult patients diagnosed with IBD (ulcerative colitis or Crohn's disease) between September 1994 and September 2019. We then examined the risk of CVA in these patients. Known risk factors such as age ≥65-years old, diabetes mellitus (DM), hypertension (HTN), female gender, atrial fibrillation (Afib) were collected. A univariate binary logistic model was constructed using CVA as the dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates was created to test for CVA.

Results: A total of 52,176,550 patients were included in this analysis, and 261,890 had IBD. The prevalence of CVA was higher in IBD patients compared to non-IBD patients (6.24% versus 0.48%, p <0.0001). The univariate binary logistic regression showed 13.7 times higher odds of having CVA in IBD patients than without IBD (odds ratio (OR) 13.74, p <0.0001). In multivariate binary logistic regression, after adjusting for traditional risk factors for CVA (Afib, HTN, female gender, DM, age ≥65 years), odds ratio of CVA in IBD patients remained significantly higher (OR 8.07, 95% CI: 7.9-8.2, p<0.0001).

Conclusion: In our large cohort of patients, IBD appears to be an independent risk factor for CVA. Further prospective studies are needed to understand the underlying mechanisms by which IBD increases the risk of CVA. This may lead to early identification and intervention to reduce the risk of CVA in this highly heterogeneous group of patients.

Keywords: CVA; IBD; cerebrovascular accident; inflammatory bowel disease.