Introduction
Inflammatory bowel disease (IBD) is associated with an increased risk of cerebrovascular disease (CVD) and coronary heart disease (CHD). It has been suggested that chronic inflammation may be the mechanism. Previous studies have primarily assessed IBD as a group and not ulcerative colitis (UC) or Crohn’s disease (CD) separately.
Aims & Methods
This study aims to determine the relationship between UC and CD and CVD and CHD risk factors/outcomes in a large UK population. General practice electronic medical records were sourced from the United Kingdom (UK) via The Health Improvement Network (THIN). UC and CD risk factors and disease outcomes were identified through Read codes.
Results
Factors
| UC
Prevalence, n (%)
n=3,432
| UC
Odds Ratio,
95% CI
| CD
Prevalence, n (%)
n=2,831
| CD
Odds Ratio,
95% CI
|
Female Sex
| 1,796 (52.3%)
| 1.16, 1.09-1.25
| 1,689 (59.7%) | 2.71, 2.08-3.62
|
Age
| 43.95 ± 14.4
| 0.99, 0.99-0.99
| 45.7 ± 15.7
| 0.95, 0.94-0.96
|
Diabetes Type II
| 417 (12.2%)
| 1.50, 1.35-1.66
| 265 (9.4%)
| 1.12, 0.98-1.27
|
Dyslipidemia
| 176 (5.1%)
| 1.26, 1.08-1.47
| 112 (4.0%)
| 0.96, 0.79-1.16
|
Obesity
| 7 (0.2%)
| 0.99, 0.47-2.10
| 7 (0.3%)
| 1.21, 0.58-2.55
|
AMI
| 113 (3.3%)
| 1.57, 1.30-1.89
| 57 (2.0%)
| 0.95, 0.73-1.23
|
Ischemic Stroke
| 47 (1.4%)
| 1.46, 1.09-1.95
| 23 (0.8%)
| 0.86, 0.57-1.30
|
Intracranial Hemorrhage
| 15 (0.4%)
| 1.67, 1.01-2.78
| 10 (0.4%)
| 1.35, 0.72-2.51
|
COPD
| 31 (0.9%)
| 1.85, 1.30-2.64
| 24 (0.9%)
| 1.74, 1.16-2.59
|
A total of 1,062,022 unique adult patients were available for analysis. There were 3,432 UC (mean age: 43.95 years, SD=14.4 years; 52% female) and 2,831 CD cases (mean age: 40.9 years, SD=14.06 years; 60% female).
Ulcerative Colitis: Univariate analysis in Table 1. Multiple logistic regression (MLR) of CHD risk factors and outcomes (adjusted in all models for age, sex, diabetes, COPD, dyslipidaemia, obesity, and statins) revealed statistically significant independent CHD risk factors: female sex (OR: 1.19, 95%CI: 1.11-1.28), younger age (OR: 0.98, 95%CI: 0.98-0.99), type 2 diabetes (OR: 1.22, 95%CI: 1.09-1.37), and increased risk of acute myocardial infarction (AMI) (OR: 1.35, 95%CI: 1.11-1.64).
MLR of CVD risk factors and outcomes (adjusted as above plus thrombolytic agents) found statistically significant independent CVD risk factors: female sex (OR: 1.19, 95%CI: 1.10-1.27), younger age (OR: 0.99, 95%CI: 0.98-0.99), diabetes type 2 (OR: 1.20, 95%CI: 1.07-1.34), statin use (OR: 1.13, 95%CI: 1.03-1.25), and any anti-thrombolytic agents (OR: 1.37, 95%CI: 1.25-1.51).
Crohn’s Disease: Univariate analysis in Table 1. MLR of CHD risk factors and outcomes (adjusted) revealed statistically significant independent CHD risk factors: female sex (OR: 0.92, 95%CI: 0.85-0.99), younger age (OR: 0.98, 95%CI: 0.97-0.99), statin use (OR: 1.23, 95%CI: 1.11-1.36), and an increased likelihood of death (OR: 1.28, 95%CI: 1.12-1.47).
MLR of CVD risk factors and outcomes (adjusted) revealed statistically significant independent CVD risk factors: female sex (OR: 0.91, 95%CI: 0.84-0.98), younger age (OR: 0.97, 95%CI: 0.96-0.98), anti-thrombolytic agents (OR: 1.71, 95%CI: 1.55-1.90), and an increased likelihood of death (OR: 1.18, 95%CI: 1.03-1.35).
Conclusion
UC cases are more likely to be female, have diabetes, be taking statins, and anti-thrombolytic agents, and have an increased risk of AMI and death. CD cases are less likely to be female, but more likely to be taking statins, anti-thrombolytic agents, and more likely to die.
Disclosure
Guy D. Eslick and Michael P. Jones have nothing to disclose. Nicholas J. Talley Disclosures: GutSee Ltd (consulting microbiome, 2025), Brown University, Agency for Health Care Research and Quality (fiber and laxation) (2024), Rome Foundation (member gastroduodenal committee) (present) Biocodex (FD diagnostic tool) (present) Microba (consulting microbiome - commencing 2025) Comvita Manuka Honey (FD trial consulting) (2025), BluMaiden outside the submitted work. In addition, Dr. Talley has a patent Nepean Dyspepsia Index (NDI) 1998, a patent Licensing Questionnaires Talley Bowel Disease Questionnaire licensed to Mayo/Talley, “Diagnostic marker for functional gastrointestinal disorders” Australian Provisional Patent Application 2021901692, ”Methods and compositions for treating age-related neurodegenerative disease associated with dysbiosis” US Patent Application No. 63/537,725.
Boards: The Gut Foundation Board (2025-present), Asia Pacific Association of Medical Editors (APAME) Board (President 2023-2025), Doctors for the Environment (Chair 2024-present), Luminal Faculty GESA (Chair) (2023-2025)
Editorial: UptoDate (Section Editor), Mayo Clinic Proceeding Associate Editor (2023-present)
Financial support: Dr. Talley is supported by funding from the National Health and Medical Research Council (NHMRC) to the Centre for Research Excellence in Digestive Health and he holds an NHMRC Investigator grant.