The Link Between Inflammatory Bowel Disease and Heart Attacks

Is there a strong link between gut health and heart health? A study led by University Hospitals Harrington Heart & Vascular Institute researchers Muhammad Panhwar, MD, and Mahazarin Ginwalla, MD, suggests there might be.

Their findings are the result of an analysis of more than 22 million patients, and examines the connection between inflammatory bowel disease (IBD) and the development of heart disease and heart attacks.

The conclusions are described in their research paper, Risk of Myocardial Infarction in Patient with Inflammatory Bowel Disease, which was recently presented at the American College of Cardiology meeting.

“Inflammation has long been recognized to play a key role in the development of heart disease,” Dr. Ginwalla says. “Our study shows an increased risk of having a heart attack in patients with inflammatory bowel disease. This increased cardiovascular risk persisted, even after adjusting for other risk factors, including diabetes, hypertension, high cholesterol and smoking – indicating that IBD should be considered a risk factor in itself for the development of heart disease.”

IBD, which should not be confused with inflammatory bowel syndrome (IBS), is an umbrella term for two chronic inflammatory conditions: Crohn’s disease and ulcerative colitis.

Most people are diagnosed with IBD before they reach their 30s. The Center for Disease Control estimates three million Americans live with IBD and 70,000 new cases are diagnosed each year. There is no known single cause of IBD, but it's believed to be due to an interplay of several genetic and environmental factors, including diet and your immune system. Some of the common symptoms of IBD include abdominal pain, diarrhea, fatigue and weight loss.

“One reason the number of Americans diagnosed with IBD is rising is because of increased awareness and earlier diagnosis,” says Dr. Ginwalla. “An early diagnosis is helpful in treating and controlling IBD symptoms, particularly for patients between the ages of 15 and 30, who are at a higher risk of developing cardiovascular problems due to increased frequency of their inflammatory flare-ups.”

The UH researchers used IBM’s Explorys, which is a large database that aggregates electronic medical records from 26 healthcare systems nationwide, for their study. What they found included:

• Heart attacks occur approximately twice as often in individuals with IBD.
• After adjusting for age, race, sex and traditional heart disease risk factors, patients with IBD had about 23 percent higher risk of having a heart attack.
• Younger patients had about nine times the risk of a heart attack compared to their peers in the same age group (who didn't have IBD).
• Among study subjects under age 40, women with IBD had a higher risk of heart attack than men with IBD.
• By age 40, both men and women with IBD had similar heart attack risks.

“Younger women with IBD appear to be at a greater risk for heart attacks according to our results,” Dr. Ginwalla says. “After age 40, the increased risk of cardiovascular problems in women begins to decrease.”

The UH researchers involved in the IBD study hope their findings will encourage patient-physician conversations about potential cardiovascular risks, Dr. Ginwalla says.

“Patients with IBD who have symptoms indicating heart disease should be evaluated by their primary care physician as soon as possible and treated appropriately,” she says. “By shining a light on these unexpected risks, we hope to raise awareness about the benefit of closer cardiovascular monitoring, preventative screening and aggressive management of risk factors for patients with IBD.”