Patients With Microscopic Colitis Are at Higher Risk of Major Adverse Cardiovascular Events: A Matched Cohort Study
Anders Forss, David Bergman, Björn Roelstraete, Johan Sundström, Ali Mahdi, Hamed Khalili, Jonas F. Ludvigsson
Abstract
Background and AimsInflammatory diseases are associated with an increased risk of incident major adverse cardiovascular events (MACE). However, data on MACE are lacking in large population-based histopathology cohorts of microscopic colitis (MC).MethodsThis study included all Swedish adults with MC without previous cardiovascular disease (1990–2017; n = 11,018). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded intestinal histopathology reports from all pathology departments (n = 28) in Sweden. MC patients were matched for age, sex, calendar year, and county with up to 5 reference individuals (n = 48,371) without MC or cardiovascular disease. Sensitivity analyses included full sibling comparisons, and adjustment for cardiovascular medication and healthcare utilization. Multivariable-adjusted hazard ratios for MACE (any of ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality) were calculated using Cox proportional hazards modelling.ResultsOver a median of 6.6 years of follow-up, 2181 (19.8%) incident cases of MACE were confirmed in MC patients and 6661 (13.8%) in reference individuals. MC patients had a higher overall risk of MACE outcomes compared with reference individuals (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.21–1.33) and higher risk of its components: ischemic heart disease (aHR, 1.38; 95% CI, 1.28–1.48), congestive heart failure (aHR, 1.32; 95% CI, 1.22–1.43), and stroke (aHR, 1.12; 95% CI, 1.02–1.23) but not cardiovascular mortality (aHR, 1.07; 95% CI, 0.98–1.18). The results remained robust in the sensitivity analyses.ConclusionsCompared with reference individuals, MC patients had a 27% higher risk of incident MACE, equal to 1 extra case of MACE for every 13 MC patients followed for 10 years. Inflammatory diseases are associated with an increased risk of incident major adverse cardiovascular events (MACE). However, data on MACE are lacking in large population-based histopathology cohorts of microscopic colitis (MC). This study included all Swedish adults with MC without previous cardiovascular disease (1990–2017; n = 11,018). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded intestinal histopathology reports from all pathology departments (n = 28) in Sweden. MC patients were matched for age, sex, calendar year, and county with up to 5 reference individuals (n = 48,371) without MC or cardiovascular disease. Sensitivity analyses included full sibling comparisons, and adjustment for cardiovascular medication and healthcare utilization. Multivariable-adjusted hazard ratios for MACE (any of ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality) were calculated using Cox proportional hazards modelling. Over a median of 6.6 years of follow-up, 2181 (19.8%) incident cases of MACE were confirmed in MC patients and 6661 (13.8%) in reference individuals. MC patients had a higher overall risk of MACE outcomes compared with reference individuals (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.21–1.33) and higher risk of its components: ischemic heart disease (aHR, 1.38; 95% CI, 1.28–1.48), congestive heart failure (aHR, 1.32; 95% CI, 1.22–1.43), and stroke (aHR, 1.12; 95% CI, 1.02–1.23) but not cardiovascular mortality (aHR, 1.07; 95% CI, 0.98–1.18). The results remained robust in the sensitivity analyses. Compared with reference individuals, MC patients had a 27% higher risk of incident MACE, equal to 1 extra case of MACE for every 13 MC patients followed for 10 years.