炎症性腸疾患は心不全のリスクを高める可能性(Inflammatory bowel disease may increase risk of heart failure)

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2024-05-21 カロリンスカ研究所(KI)

カロリンスカ研究所の大規模レジストリ研究によると、炎症性腸疾患(IBD)は診断後最大20年間、心不全リスクがわずかに増加することが判明しました。この研究では、クローン病、潰瘍性大腸炎、未分類IBDの患者8万人以上と一般人口40万人を比較しました。その結果、IBD患者は診断後20年間に心不全を発症するリスクが19%増加し、130人のIBD患者ごとに1件の追加心不全が発生しました。特に高齢者、低学歴者、心血管関連疾患を持つ患者でリスクが高かったです。兄弟姉妹との比較でもリスク増加が確認され、遺伝や環境要因が影響する可能性があります。研究は新しい心血管疾患管理ガイドラインの策定に貢献することを期待しています。

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炎症性腸疾患における心不全リスク:スウェーデンの集団ベース研究 Risk of heart failure in inflammatory bowel disease: a Swedish population-based study

Jiangwei Sun, PhD, Jialu Yao, MSc, Ola Olén, MD, PhD, Jonas Halfvarson, MD, PhD, David Bergman, MD, PhD, Fahim Ebrahimi, MD, MSc, Annika Rosengren, MD, PhD, Johan Sundström, MD, PhD, Jonas F Ludvigsson, MD, PhD
European Heart Journal  Published:21 May 2024
DOI:https://doi.org/10.1093/eurheartj/ehae338

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

炎症性腸疾患は心不全のリスクを高める可能性(Inflammatory bowel disease may increase risk of heart failure)

医療・健康
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