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, Jiangwei Sun, PhD Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden Correspondence: Jiangwei Sun, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 65 Solna, Sweden. Email: jiangwei.sun@ki.se Search for other works by this author on: Oxford Academic Jialu Yao, MSc Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden Search for other works by this author on: Oxford Academic Ola Olén, MD, PhD Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet , Stockholm , Sweden Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet , Stockholm , Sweden Search for other works by this author on: Oxford Academic Jonas Halfvarson, MD, PhD Search for other works by this author on: Oxford Academic David Bergman, MD, PhD Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden Search for other works by this author on: Oxford Academic Fahim Ebrahimi, MD, MSc Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden Department of Gastroenterology and Hepatology, Clarunis University Center for Gastrointestinal and Liver Diseases , Basel , Search for other works by this author on: Oxford Academic Annika Rosengren, MD, PhD Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden Sahlgrenska University Hospital VG-Region , Gothenburg , Sweden Search for other works by this author on: Oxford Academic Johan Sundström, MD, PhD Department of Medical Sciences, Uppsala University , Sweden Search for other works by this author on: Oxford Academic Jonas F Ludvigsson, MD, PhD Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden Department of Pediatrics, Örebro University Hospital , Örebro , Sweden Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center , New York , USA Search for other works by this author on: Oxford Academic
European Heart Journal, ehae338, https://doi.org/10.1093/eurheartj/ehae338
Published:
21 May 2024
Article history
Received:
19 October 2023
Revision received:
17 April 2024
Accepted:
16 May 2024
Published:
21 May 2024
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Jiangwei Sun, Jialu Yao, Ola Olén, Jonas Halfvarson, David Bergman, Fahim Ebrahimi, Annika Rosengren, Johan Sundström, Jonas F Ludvigsson, Risk of heart failure in inflammatory bowel disease: a Swedish population-based study, European Heart Journal, 2024;, ehae338, https://doi.org/10.1093/eurheartj/ehae338
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Abstract
Background and Aims
Dysregulation of inflammatory and immune responses has been implicated in the pathogenesis of heart failure (HF). But even if inflammation is a prerequisite for inflammatory bowel disease (IBD), little is known about HF risk in IBD.
Methods
In this Swedish nationwide cohort, patients with biopsy-confirmed IBD were identified between 1969 and 2017 [n = 81,749, Crohn’s disease (CD, n = 24,303), ulcerative colitis (UC, n = 45,709), and IBD-unclassified (IBD-U, n = 11,737)]. Each patient was matched with up to five general population reference individuals (n = 382,190) and IBD-free full siblings (n = 95,239) and followed until 31 December 2019. Flexible parametric survival models estimated the adjusted hazard ratio (aHR) and standardized cumulative incidence for HF, with 95% confidence intervals (CI).
Results
There were 5,582 incident HF identified in IBD patients (incidence rate [IR]: 50.3/10,000 person-years) and 20,343 in reference individuals (IR: 37.9) during a median follow-up of 12.4 years. IBD patients had a higher risk of HF than reference individuals (aHR 1.19, 95% CI 1.15 to 1.23). This increased risk remained significant ≥20 years after IBD diagnosis, leading to one extra HF case per 130 IBD patients until then. The increased risk was also observed across IBD subtypes: CD (IR: 46.9 vs. 34.4; aHR 1.28 [1.20 to 1.36]), UC (IR: 50.1 vs. 39.7; aHR 1.14 [1.09 to 1.19]), and IBD-U (IR: 60.9 vs. 39.0; aHR 1.28 [1.16 to 1.42]). Sibling-controlled analyses showed slightly attenuated association (IBD: aHR 1.10 [1.03 to 1.19]).
Conclusions
Patients with IBD had a moderately higher risk of developing HF for ≥20 years after IBD diagnosis than the general population.
Graphical Abstract
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inflammatory bowel disease, heart failure, nationwide, cohort
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Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout.
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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Topic:
- heart failure
- inflammatory bowel disease
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- Human Immunology of Heart Failure: Deconstructing Inflammatory Risk
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