Risk of heart failure in inflammatory bowel disease: a Swedish population-based study

Author:

Sun Jiangwei1ORCID,Yao Jialu1,Olén Ola234,Halfvarson Jonas5ORCID,Bergman David1ORCID,Ebrahimi Fahim16,Rosengren Annika78ORCID,Sundström Johan910,Ludvigsson Jonas F11112ORCID

Affiliation:

1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden

2. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet , Stockholm , Sweden

3. Sachs’ Children and Youth Hospital, Stockholm South General Hospital , Stockholm , Sweden

4. Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet , Stockholm , Sweden

5. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University , Örebro , Sweden

6. Department of Gastroenterology and Hepatology, Clarunis University Center for Gastrointestinal and Liver Diseases , Basel , Switzerland

7. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden

8. Sahlgrenska University Hospital VG-Region , Gothenburg , Sweden

9. Department of Medical Sciences, Uppsala University , Uppsala , Sweden

10. The George Institute for Global Health, University of New South Wales , Sydney , Australia

11. Department of Pediatrics, Örebro University Hospital , Örebro , Sweden

12. Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center , New York, New York State , USA

Abstract

Abstract Background and Aims Dysregulation of inflammatory and immune responses has been implicated in the pathogenesis of heart failure (HF). But even if inflammation is a prerequisite for inflammatory bowel disease (IBD), little is known about HF risk in IBD. Methods In this Swedish nationwide cohort, patients with biopsy-confirmed IBD were identified between 1969 and 2017 [n = 81 749, Crohn’s disease (CD, n = 24 303), ulcerative colitis (UC, n = 45 709), and IBD-unclassified (IBD-U, n = 11 737)]. Each patient was matched with up to five general population reference individuals (n = 382 190) and IBD-free full siblings (n = 95 239) and followed until 31 December 2019. Flexible parametric survival models estimated the adjusted hazard ratio (aHR) and standardized cumulative incidence for HF, with 95% confidence intervals (CI). Results There were 5582 incident HF identified in IBD patients (incidence rate [IR]: 50.3/10 000 person-years) and 20 343 in reference individuals (IR: 37.9) during a median follow-up of 12.4 years. IBD patients had a higher risk of HF than reference individuals (aHR 1.19, 95% CI 1.15–1.23). This increased risk remained significant ≥20 years after IBD diagnosis, leading to one extra HF case per 130 IBD patients until then. The increased risk was also observed across IBD subtypes: CD (IR: 46.9 vs. 34.4; aHR 1.28 [1.20–1.36]), UC (IR: 50.1 vs. 39.7; aHR 1.14 [1.09–1.19]), and IBD-U (IR: 60.9 vs. 39.0; aHR 1.28 [1.16–1.42]). Sibling-controlled analyses showed slightly attenuated association (IBD: aHR 1.10 [1.03–1.19]). Conclusions Patients with IBD had a moderately higher risk of developing HF for ≥20 years after IBD diagnosis than the general population.

Funder

European Crohn’s and Colitis Organization

Stiftelsen Professor Nanna Svartz fond

Swedish Society for Medical Research

Swedish Research Council for Health, Working Life and Welfare

Swiss National Science Foundation

Swedish Research Council

Publisher

Oxford University Press (OUP)

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