Patients with inflammatory bowel disease (IBD) are at increased risk for stroke, especially ischemic stroke, for at least 25 years after diagnosis.
IBD, which causes chronic intestinal inflammation, encompasses Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U).
The population-based cohort study included 85,006 patients with biopsy-confirmed IBD between 1969 and 2019, a matched reference group drawn from the general population and IBD-free siblings.
Covariates included country of birth, socioeconomic status, healthcare-seeking behavior, and cardiovascular-related comorbidities and medication use prior to the index date.
The primary outcome was incident overall stroke; secondary outcomes were incident ischemic and hemorrhagic stroke (including intracranial hemorrhage and subarachnoid hemorrhage).
During a median follow-up of about 12 years, there were 3720 incident strokes in IBD patients (incidence rate [IR] 32.6 per 10,000 person-years) compared with 15,599 in the reference individuals (IR, 27.7).
After multivariable adjustment, IBD patients were at increased risk for overall stroke (adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08 – 1.17) and ischemic stroke (aHR, 1.14; 95% CI,1.09 – 1.18), but not hemorrhagic stroke (aHR, 1.06; 95%CI, 0.97 – 1.15).
The aHR for overall stroke remained increased even 25 years after diagnosis, corresponding to one additional stroke case per 93 IBD patients until then.
Individuals with different subtypes of IBD were also at significantly increased risk for overall stroke.
The sibling comparison also showed IBD patients had significantly higher risk for overall stroke and ischemic stroke but not hemorrhagic stroke.
In subgroup analyses, the aHR for overall stroke was higher in women (1.20, vs 1.06 in men), in those with younger onset IBD, and those diagnosed from 2010 to 2019.
These results along with earlier data “indicate that ischemic stroke is one of the most clinically important CVD-related outcomes in IBD patients” write the authors, who urged screening and management of stroke risk factors in IBD patients and development of relevant guidelines.
The study was conducted by Jiangwei Sun, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden, and colleagues. It was published online June 14 in the journal Neurology.
The matched references may have included patients with undiagnosed stroke, which may dilute the real association. Changes in the diagnostic criteria for IBD and stroke over the study period may affect the associations. The study lacked complete data on all protective and stroke risk factors, such as diet and other lifestyle factors, that may confound the association, and data on inflammatory markers.
This study was supported by the Swedish Research Council. Several authors declared relationships with industry. The full list can be found with the original article.
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