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The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National Study
Open accessAbstract
BACKGROUND: Inflammatory bowel disease (IBD) has been associated with an increased risk of cardiovascular events, but the risk of cerebrovascular accidents (CVA) remains unknown. Hypercoagulability and systemic inflammation are two proposed mechanisms by which the presence of IBD might lead to the development of CVA. OBJECTIVE: To assess the risk of CVA in patients with IBD compared to those without IBD with known traditional risk factors for CVA. METHODS: We reviewed data from a large commercial database (Explorys, IBM) that aggregated records from 26 health-care systems nationwide. Using systemized nomenclature of medicine - clinical terms, we identified adult patients diagnosed with IBD (ulcerative colitis or Crohn's disease) between September 1994 and September 2019. We then examined the risk of CVA in these patients. Known risk factors such as age ≥65-years old, diabetes mellitus (DM), hypertension (HTN), female gender, atrial fibrillation (Afib) were collected. A univariate binary logistic model was constructed using CVA as the dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates was created to test for CVA. RESULTS: A total of 52,176,550 patients were included in this analysis, and 261,890 had IBD. The prevalence of CVA was higher in IBD patients compared to non-IBD patients (6.24% versus 0.48%, p <0.0001). The univariate binary logistic regression showed 13.7 times higher odds of having CVA in IBD patients than without IBD (odds ratio (OR) 13.74, p <0.0001). In multivariate binary logistic regression, after adjusting for traditional risk factors for CVA (Afib, HTN, female gender, DM, age ≥65 years), odds ratio of CVA in IBD patients remained significantly higher (OR 8.07, 95% CI: 7.9-8.2, p<0.0001). CONCLUSION: In our large cohort of patients, IBD appears to be an independent risk factor for CVA. Further prospective studies are needed to understand the underlying mechanisms by which IBD increases the risk of CVA. This may lead to early identification and intervention to reduce the risk of CVA in this highly heterogeneous group of patients.
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“Inflammatory bowel disease has been associated with a higher risk of cerebrovascular accidents [99] according to a study including 261,890 IBD patients compared to non-IBD patients (6.24% vs. 0.48%, p < 0.0001) [100].”
From Association between Childhood Onset Inflammatory Bowel Disease and Psychiatric Comorbidities in Adulthood (2023) · cites this paper as [100]
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Cites
Inflammation, Atherosclerosis, and Coronary Artery Disease
Hansson, G. K. (2005) · New England Journal of Medicine · doi:10.1056/nejmra043430 · Cited by 8,773
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Stroke risk factors, genetics, and prevention
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Risk Factors for Cardiovascular Disease in Systemic Lupus Erythematosus
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Interactions between Intestinal Microbiota and Host Immune Response in Inflammatory Bowel Disease
Zhang, M., Sun, K., Wu, Y., Yang, Y., Tso, P., & Wu, Z. (2017) · Frontiers in Immunology · doi:10.3389/fimmu.2017.00942 · Cited by 347
Influence of Age and Health Behaviors on Stroke Risk: Lessons from Longitudinal Studies
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He, J., Zhang, S., Qiu, Y., Liu, F., Liu, Z., Tan, J., Hu, F., Wu, X., Wang, Y., Zhou, L., et al. (2022) · United European Gastroenterology Journal · doi:10.1002/ueg2.12351 · Cited by 33
Diabetes Mellitus and Heart Failure With Preserved Ejection Fraction: Role of Obesity
Dhore-Patil, A., Thannoun, T., Samson, R., & Jemtel, T. H. L. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2021.785879 · Cited by 27
Self-citationSălcudean, A., Nan, A. G., Bodo, C. R., Cosma, M. C., Strete, E. G., & Lica, M. M. (2023) · Diagnostics · doi:10.3390/diagnostics13111868 · Cited by 24
Jalil, J., Gabrielli, L., Ocaranza, M. P., MacNab, P., Fernández, R., Grassi, B. A., Jofré, P., Verdejo, H., Mónica Acevedo, B., Samuel Córdova, A., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25084407 · Cited by 25
Atherosclerotic cardiovascular diseases in inflammatory bowel diseases: to the heart of the issue
Gabbiadini, R., Buono, A. D., Mastrorocco, E., Solitano, V., Repici, A., Spinelli, A., Condorelli, G., & Armuzzi, A. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1143293 · Cited by 21
Metadata
- Authors
- Ghoneim, S., Shah, A., Dhorepatil, A., Butt, M. U., & Waghray, N.
- Affiliations
- MetroHealth (US)
- Corresponding author
- Ghoneim, Sara
- Venue
- Clinical and Experimental Gastroenterology
- Publisher
- Informa UK Limited
- Published
- 2020-05
- Volume
- Volume 13
- Pages
- 123-129
- ISSN
- 1178-7023 (ISSN-L)
- PMC
- PMC7210027
- OpenAlex
- W3023230420
- Cited by
- 16
- References
- 34
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical and Experimental Gastroenterology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- inflammatory bowel disease, stroke, stroke risk, ulcerative colitis, Crohn's disease, hypercoagulability, systemic inflammation, cardiovascular risk factors, atrial fibrillation, hypertension, diabetes mellitus, older adults, sex differences, United States, population-based cohort, risk stratification
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- Ghoneim, S., Shah, A., Dhorepatil, A., Butt, M. U., & Waghray, N. (2020). The Risk of Cerebrovascular Accidents in Inflammatory Bowel Disease in the United States: A Population-Based National Study. Clinical and Experimental Gastroenterology. https://doi.org/10.2147/ceg.s250182
