P1575 - Coronary Artery Calcium Score for Assessment of Cardiovascular Risk in Patients With Inflammatory Bowel Disease

Maahum Mehdi, BS¹, Jordan Hanrahan, DO², Rebekah J. Walker, MD³, Sneha Nagavally, MS², Jacquelyn Kulinski, MD³, Salim S. Virani, MD, PhD⁴, Jeffry Katz, MD⁵, Emad Mansoor, MD⁵, Raymond K. Cross, MD, MS⁶, Preetika Sinh, MD^3
1Medical College of Wisconsin, Mequon, WI; ²Medical College of Wisconsin, Wauwatosa, WI; ³Medical College of Wisconsin, Milwaukee, WI; ⁴Baylor College of Medicine, Houston, TX; ⁵University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; ⁶University of Maryland School of Medicine, Baltimore, MD

Introduction: Inflammatory bowel disease (IBD) is associated with increased atherosclerotic cardiovascular (ASCVD) risk. We used CT coronary artery calcium (CAC) score to determine CVD risk in IBD patients with assessment of disease activity and medications.

Methods: We retrospectively compared IBD (ICD10 codes) and non IBD controls between 45-85 years of age who had undergone CT scan for CAC scoring between 2003 to 2020. Demographic, traditional (Table) and non-traditional (IBD activity score, lab) ASCVD risk factor, and medication data was collected. Cases and controls with other chronic inflammatory disorders, HIV, malignancy and familial hypercholesterolemia were excluded. The primary outcome was CAC Agatston score (mean and stratified as < 0 very low, 0-99 low, 100-399 moderate and > 400 high life-time risk for CV events) and CVD risk scores (AHA/ACC ASCVD risk score using pooled cohort risk equations and MESA-CAC score). Secondary outcome was ASCVD event [MI, unstable angina, revascularization, stroke, heart failure, death, peripheral arterial disease and arrhythmia]. Descriptive statistics, two sample t-test and chi-square were used for comparison. Comparison between mean CAC was performed by age group (45-66 vs. 65-85 years). Unadjusted and adjusted regression models were performed for primary outcomes. P< 0.05 was significant.

Results: 35 IBD and 65 non IBD patients were identified. There was no significant difference in demographics, traditional risk factors and lab values between the two groups except higher prevalence of hypertension and hyperlipidemia in non IBD controls (Table). Most IBD patients (82%) had inactive disease by imaging. 37% of IBD patients were on immunomodulators or biologics. There was no difference in mean CAC [191(SD 384,) vs 224(SD 587), p=0.76], CAC score [0=34% vs 45%, 1-99=34% vs 20%, 100-399=14% vs 23%, >400=17% vs 11%, p=0.26], ASCVD risk score [9.2%(SD12) vs 8.3%(SD8.0), p=0.69], MESA CAC score [6.8%(SD 6.7) vs 7.2%(SD8.0), p=0.83] or total CV events [4(12%) vs 10(15%), p=0.6] between IBD and non IBD controls. There was wider numerical difference in mean IBD score for those in the 66-76 age range compared to 45-65 age range (Figure). Adjusted mean CAC score (for age, gender and traditional risk factors) was not statistically significant between groups.

Discussion: ASCVD risk is not increased in IBD patients as assessed by CAC. Larger prospective studies are needed to determine the role of CAC across various age groups and disease scores in patients with IBD.


Figure: CAC score stratified by age in IBD and non IBD patients
Legends: A- IBD, B- non IBD

Demographics	IBD (n=35)	Non-IBD (n=65)	p-value
Age (y, means +/- SD)	60.5 (6.1)	57.2 (8.1)	0.04
Gender n (%) Female Male	15 (42.9) 20 (57.1)	25 (38.5) 40 (61.5)	0.7
Race n (%) White Black or African American Asian Native Hawaiian or Other Pacific Islander Unknown	33 (94.3) 2 (5.7) 0 (0) 0 (0) 0 (0)	60 (92.3) 1 (1.5) 1(1.5) 2(3.1) 1(1.5)	0.5
Traditional Risk Factors
BMI n (%) Normal Overweight/Obese	9 (25.7) 26 (74.3)	15 (23.8) 48 (76.2)	0.8
HTN n (%)	9 (25.7)	32 (49.2)	0.02
DM n (%)	2 (5.7)	5 (7.7)	0.7
CKD n (%)	0 (0)	2 (3.1)	0.03
HLD n (%)	17 (48.6)	45 (69.2)	0.04
Smoking history n (%) Current smoker Former smoker	2 (5.7) 11 (31.4)	5 (7.8) 17 (26.6)	0.8
Alcohol use n (%) Occasional Low risk/High risk	26 (74.3) 3 (8.6)	38 (59.4) 7 (10.9)	0.3
Non-Traditional Risk Factors
IBD Type n (%) Crohn's Disease Ulcerative Colitis Indeterminate Colitis	9 (25.7) 16 (45.7) 10 (28.6)	- - -
Disease Duration n (%) < 5 years 5-10 years >10 years	8 (24.2) 21 (63.6) 4 (12.1)	- - -
Montreal Classification: UC n (%) Proctitis Left-sided Extensive	6 (42.9) 5 (35.7) 3 (21.4)	- - -
Montreal Classification: CD n (%) Ileal Colonic Ileocolonic Non-stricturing/penetrating Stricturing/penetrating Perianal	1 (11.1) 3 (33.3) 5 (55.6) 2 (37.5) 5 (62.5) 0 (0)	- - - - - -
Disease Activity n (%) Harvey Bradshaw index mean (SD) Partial Mayo score (SD) SIBDQ score	1.4 (1.8) - 50.4 (12.2)	- - -
Disease by imaging (active/inactive) n (%) Active Inactive	4 (23.5) 13 (82.5)	- -
Disease by endoscopy SESCD score (n) - CD Mayo score (n) - UC	0 (1) 2 (1)	- -
IBD Medication n (%) Mesalamine Steroids Immunomodulators Anti-TNF Immunomodulators/Anti-TNF comb Ustekinumab	18 (51.4) 15 (42.9) 7 (20.0) 3 (8.6) 2 (5.7) 1 (2.9)	- - - - - -
Non-IBD Medications n(%) Anti-hypertensives Diabetic medications Statin Aspirin Anti-platelets Anticoagulants	13 (37.1) 6 (17.2) 16 (45.7) 7 (20.0) 0 (0) 2 (5.7)	35 (53.8) 16 (24.6) 37 (56.9) 25 (38.5) 1 (1.6) 3 (4.6)	0.1 0.4 0.3 0.1 0.5 0.8
Laboratory value means (SD) Albumin (gm/dL) Platelets (k/mm3) WBC (x103/mm3) Hemoglobin CRP (mg/dL) Vitamin D (ng/mL) LDL-C (mg/dL) HDL-C (mg/dL) Total Cholesterol (mg/dL) Triglycerides (mg/dL)	4.3 (0.3) 204.3 (54.7) 6.8 (2.8) 13.9 (1.6) 1.5 (4.3) 19.6 (1.3) 102.6 (31.8) 55.2 (7.9) 181.0 (45.9) 116.6 (57.5)	4.3 (0.4) 242.1 (51.0) 6.6 (1.9) 14.3 (1.4) 0.4 (0.3) 44.9 (21.0) 127.5 (50.7) 58.1 (25.3) 206.8 (53.6) 120.2 (46.3)	0.6 0.2 0.3 0.1 0.3 0.1 0.3 0.8 0.3 0.9

Table: Table 1. Comparison of Demographics, Traditional and Non-Traditional Risk Factors between IBD and Non IBD patients

Footnotes: IBD: inflammatory bowel disease; BMI: body mass index; HTN: hypertension; DM: diabetes; CKD: chronic kidney disease, HLD: hyperlipidemia; SIBDQ: short inflammatory bowel disease questionnaire; SESCD: simple endoscopic score for Crohn’s disease; TNF: tumor necrosis factor; WBC: white cell count; CRP: c-reactive protein; LDL-C: low density lipoprotein- cholesterol; HDL: high density lipoprotein.


Disclosures:
Maahum Mehdi indicated no relevant financial relationships.
Jordan Hanrahan indicated no relevant financial relationships.
Rebekah Walker indicated no relevant financial relationships.
Sneha Nagavally indicated no relevant financial relationships.
Jacquelyn Kulinski indicated no relevant financial relationships.
Salim Virani indicated no relevant financial relationships.
Jeffry Katz indicated no relevant financial relationships.
Emad Mansoor indicated no relevant financial relationships.
Raymond Cross indicated no relevant financial relationships.
Preetika Sinh indicated no relevant financial relationships.


Maahum Mehdi, BS¹, Jordan Hanrahan, DO², Rebekah J. Walker, MD³, Sneha Nagavally, MS², Jacquelyn Kulinski, MD³, Salim S. Virani, MD, PhD⁴, Jeffry Katz, MD⁵, Emad Mansoor, MD⁵, Raymond K. Cross, MD, MS⁶, Preetika Sinh, MD³. P1575 - Coronary Artery Calcium Score for Assessment of Cardiovascular Risk in Patients With Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.