Prevalence of cardiovascular risk factors in a nationally representative adult population with inflammatory bowel disease without atherosclerotic cardiovascular disease





Abstract


Background and aims


Chronic inflammation is associated with premature atherosclerotic cardiovascular disease (ASCVD). We studied the prevalence of cardiovascular risk factors (CRFs) amongst individuals with IBD who have not developed ASCVD.


Methods


Our study population was derived from the 2015 – 2016 National Health Interview Survey. Those with ASCVD (defined as myocardial infarction, angina or stroke) were excluded. The prevalence of CRFs among individuals with IBD was compared with those without IBD. The odds CRFs among adults with IBD was assessed using logistic regression models.


Results


In our study population of 60,155 individuals, 786 (1.3%) had IBD. IBD was associated with increased odds hypertension (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.39–2.09), diabetes (OR 1.68, 95% CI 1.22–2.32), hypercholesterolemia (OR 1.62, 95% CI 1.32–2.99) and insufficient physical activity (OR 1.38, 95% CI 1.16–1.66).


Conclusion


IBD is associated with higher prevalence of CRFs. Early screening and risk mitigation strategies are warranted.



Introduction


Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract comprising Crohn’s disease (CD), ulcerative colitis (UC) and indeterminate colitis. IBD is believed to be triggered by a dysregulated local mucosal immune response to commensal intraluminal microbes in genetically predisposed individuals [ , ]. CD and UC differ in the extent and type of intestinal inflammatory response, however, both are characterized by the presence of systemic inflammation and often, extra-intestinal clinical manifestations .


Inflammation plays a key role in atherogenesis as well as plaque destabilization . There is compelling evidence demonstrating that conditions characterized by chronic inflammation such as rheumatoid arthritis, systemic lupus erythematosus and psoriasis are associated with accelerated atherosclerosis and higher risk of premature atherosclerotic cardiovascular disease (ASCVD) [ , ]. In this context, recent studies have also portrayed an increased risk of ASCVD in patients with IBD [ , ].


There is, however, a paucity of data in terms of the burden of cardiovascular risk factors (CRF) among IBD patients who have not yet developed clinical ASCVD. This knowledge can shed light on the intermediate mechanisms that result in an increased risk of ASCVD in IBD, identifying opportunities for enhanced early preventive efforts. Accordingly, in this study we sought to describe the prevalence of CRFs among patients with IBD from a nationally representative US sample who had not developed clinical ASCVD.



Methods


We used data from the 2015–2016 National Health Interview Survey (NHIS), a cross-sectional household interview survey conducted annually by the National centre for Health Statistics under the auspices of the Centres for Disease Control and Prevention (CDC). Our study utilized publicly available de-identified data and therefore was exempt from IRB approval. The survey collects information on the health of the civilian non-institutionalised population using a multi-stage, complex design in order to produce nationwide estimates . We included all adults ≥ 18 years of age without established ASCVD. This was self-reported and included coronary artery disease (“Yes” to any of the following 3 questions: “Have you ever been told by a doctor or other health professional that you had … coronary heart disease?”, “… angina, also called angina pectoris?”, “… a heart attack (also called myocardial infarction)?” ) and stroke (“Yes” to the following question: “Have you ever been told by a doctor or other health professional that you had a stroke?” ). Presence of IBD was self-reported and ascertained as an affirmative response to: “Have you ever been told by a doctor or other health professional that you had Crohn’s disease or ulcerative colitis?” CRFs were also self-reported and included hypertension, diabetes, hypercholesterolemia, smoking, obesity (BMI ≥30 kg/m 2 ; calculated by self-reported height and weight), and insufficient physical activity. Insufficient physical activity was defined as not participating in >=150 min per week of moderate-intensity aerobic physical activity, >=75 min per week of vigorous-intensity aerobic physical activity, or a total combination of ≥150 min per week of moderate/vigorous-intensity aerobic physical activity. Further, for the present analyses we created a CRF profile, with 3 mutually-exclusive categories based on the presence of individual CRFs: 0–1 (“optimal”), 2–3 (“average”), and ≥ 4 (“poor”) [ , ].


We obtained national estimates for the proportion of individuals with and without IBD using survey-specific descriptive analyses. We used weighted univariate and multivariable logistic regression models to evaluate the association between IBD and CRFs. We also used a multinomial logistic regression analysis (using optimal cardiovascular risk factor as reference) to evaluate the association between IBD and cardiovascular risk factor profile. Additionally, we conducted subgroup analyses of the association between IBD and CRFs by age groups (non-elderly [<65 years] vs. elderly [≥65 years]) in order to assess the differential relationship, if any, between CRFs and IBD by age. We obtained variance estimations and person-level weights for the pooled cohort from the Integrated Public Use Microdata Series website ( www.ipums.org ) . All analyses were performed using Stata version 16.1 (StataCorp, College Station, TX).



Results


Of 66,700 participants included in the 2015–2016 NHIS, 60,155 did not have clinical ASCVD and were used to define our study population. Of these, 786 (1.3%) had IBD and 59,299 (98.57%) did not have IBD, representing 2.6 million and 221.1 million adults, respectively, in the US. Elderly individuals (those aged ≥ 65 years) represented 21.9% of the study population with IBD, and 16% of those without IBD ( Table 1 ).



Table 1

Demographic characteristics and prevalence of cardiovascular risk factors and risk factor profile by IBD status in individuals without ASCVD from the National Health Interview Survey 2015–2016.






































































































































































































































































Overall population Age <65 years Age ≥65 years
IBD [n(%)] No IBD [n(%)] p-values IBD [n(%)] No IBD [n(%)] p-values IBD [n(%)] No IBD [n(%)] p-values
Sample 786 59,299 570 46,327 216 12,972
Weighted sample 2621,113 (1.2) 221,128,345 (98.8) 2047,846 (1.1) 185,769,382 (98.9) 573,259 (1.6) 35,358,971 (98.4)
Age (years), mean (SD) 53.1 (16.6) 48.6 (18.1) 45.6 (12.7) 41.4 (13.3) 72.8 (6.4) 73.6 (6.5)
Sex, n (weighted%) <0.001 0.007 0.014
Male 266 (38.6) 26,374 (47.7) 211 (41.1) 21,287 (48.9) 55 (29.6) 5087 (41.6)
Female 520 (61.4) 32,925 (52.3) 359 (58.9) 25,040 (51.1) 161 (70.4) 7885 (58.4)
Race/ethnicity <0.001 <0.001 0.7
Non-Hispanic white 618 (75.9) 39,014 (65.1) 437 (74.1) 29,150 (62.6) 181 (82.1) 9864 (77.8)
Non-Hispanic Black 56 (6.4) 7323 (12.3) 44 (6.3) 5968 (13.0) 12 (6.6) 1355 (9.0)
Non-Hispanic Asian 22 (3.8) 3435 (6.2) 16 (3.9) 2860 (6.5) 6 (3.6) 575 (4.8)
Hispanic 81 (13.9) 8698 (16.4) 65 (15.6) 7638 (17.9) 16 (7.6) 1060 (8.3)
Risk factors
Hypertension 320 (39.1) 18,221 (27.3) <0.001 173 (31.0) 10,601 (21.5) <0.001 147 (68.1) 7620 (58.1) 0.024
Diabetes 90 (12.4) 5077 (7.8) 0.001 50 (9.6) 2844 (5.8) 0.009 40 (22.1) 2233 (18.5) 0.34
Hypercholesterolemia 265 (33.5) 15,212 (23.7) <0.001 156 (27.4) 9016 (19.0) <0.001 109 (55.3) 6196 (48.4) 0.14
Smoking (current vs former/never) 136 (15.7) 9403 (15.0) 0.70 123 (18.0) 8293 (16.3) 0.38 13 (7.2) 1110 (8.1) 0.72
Obesity 257 (32.6) 19,045 (31.8) 0.73 181 (32.0) 15,242 (32.3) 0.91 76 (34.6) 3803 (29.0) 0.16
Insufficient physical activity 416 (55.8) 28,295 (47.7) <0.001 277 (52.4) 20,696 (45.6) 0.01 139 (68.2) 7599 (58.9) 0.04
CRF profile <0.001 0.003 <0.001
Optimal 319 (43.7) 30,177 (56.0) 275 (51.5) 26,293 (60.4) 44 (16.7) 3884 (32.0)
Average 338 (43.3) 21,480 (35.9) 217 (38.1) 15,248 (33.0) 121 (61.6) 6232 (51.2)
Poor 97 (12.9) 5285 (8.2) 54 (10.4) 3217 (6.6) 43 (21.7) 2068 (16.8)

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Jul 16, 2021 | Posted by in CARDIOLOGY | Comments Off on Prevalence of cardiovascular risk factors in a nationally representative adult population with inflammatory bowel disease without atherosclerotic cardiovascular disease
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