Motasem Alkhayyat, MD1, Mohammad Abureesh, MD2, Mohannad Abou Saleh, MD1, Mohammad Zmaili, MD1, Jafar Alzubi, MD3, Ashraf Almomani, MD1, Emad Mansoor, MD4, Sara El Ouali, MD1, Miguel Regueiro, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2Staten Island University Hospital, New York City, NY; 3Cleveland Clinic Foundation, Akron, OH; 4University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: There appears to be an increased risk of myocardial infarction (MI) in inflammatory bowel disease (IBD) patients. However, prior studies did not evaluate the impact of IBD medications. Using a large database, we sought to describe the association of IBD with MI and the effect of IBD treatment. Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of (SNOMED-CT) IBD between 2016-2020 was identified. Subsequently a cohort of patients who developed MI after at least 30 days from IBD diagnosis was identified. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. Results: Of the 39,328,760 individuals in the database, 181,670 had CD (0.46%) and 154,500 (0.39%) had UC. The prevalence of patients with new diagnosis of MI after at least 30 days of CD, UC, and general population were 8.6% , 7.0%, and 2.7% respectively, P< 0.0001. Compared to non-IBD, patients with a history of IBD had a higher risk association of MI; [OR: 3.68; 95% CI: 3.56-3.81] for CD and [2.72 (2.66-2.77)] for UC. Figure 1 illustrates the overall odds of MI among IBD patients stratified by age group. IBD patients on biologics [CD: infliximab: 0.32 (0.30-0.35), adalimumab: 0.34 (0.31-0.37), certolizumab: 0.33 (0.27-0.41), vedolizumab: 0.37 (0.31-0.43), and ustekinumab: 0.24 (0.19-0.31)] and [UC: infliximab: 0.50 (0.45-0.56), adalimumab: 0.52 (0.47-0.58), vedolizumab: 0.45 (0.38-0.54), and ustekinumab: 0.42 (0.29-0.61)], thiopurines [CD: azathioprine: 0.42 (0.39-0.45) and 6-MP: 0.37 (0.33-0.42)] and [UC: 0.72 (0.66-0.78) and 0.62 (0.54-0.71) respectively], and 5ASAs [CD: 0.58 (0.56-0.61), UC: 0.78 (0.74-0.81) ] had a significantly lower risk of developing MI while natalizumab, and tofacitinib were associated with a nonsignificant lower risk (Table 1). Discussion: In this large database, we found a higher risk association between MI and IBD. Patients treated with anti-TNFs, vedolizumab, ustekinumab, thiopurines, or 5-ASA had lower risk of developing MI compared to those who did not receive treatment. The inflammatory effects of IBD may be associated with cardiovascular disease and certain IBD treatments may reduce the risk of MI.
Figure 1: Overall odds of MI among IBD patients
Disclosures: Motasem Alkhayyat indicated no relevant financial relationships. Mohammad Abureesh indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Mohammad Zmaili indicated no relevant financial relationships. Jafar Alzubi indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Emad Mansoor indicated no relevant financial relationships. Sara El Ouali indicated no relevant financial relationships. Miguel Regueiro indicated no relevant financial relationships.