Pearl Zakroysky1, Wai-Ee Thai2, Roderick C Deaño3, Sandeep Basnet2, Zurine Galvan Onandia2, Sachin Gandhi2, Ahmed Tawakol2, James K Min4, Quynh A Truong4. 1. Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts. 2. Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 3. Division of Cardiovascular Disease, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York. 4. Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
Abstract
BACKGROUND: Steroids are anti-inflammatory agents commonly used to treat inflammatory bowel disease. Inflammation plays a critical role in the pathophysiology of both inflammatory bowel disease and acute coronary syndrome. We examined the relationship between steroid use in patients with inflammatory bowel disease and acute coronary syndrome. METHODS: In 177 patients with inflammatory bowel disease (mean age 67 years, 75% male, 44% Crohn's disease, 56% ulcerative colitis), we performed a 1:2 case-control study matched for age, sex, and inflammatory bowel disease type, and compared 59 patients with inflammatory bowel disease with acute coronary syndrome to 118 patients with inflammatory bowel disease without acute coronary syndrome. Steroid use was defined as current or prior exposure. Acute coronary syndrome was defined as myocardial infarction or unstable angina, confirmed by cardiac biomarkers and coronary angiography. RESULTS: In patients with inflammatory bowel disease, 34% with acute coronary syndrome had exposure to steroids, vs 58% without acute coronary syndrome (P < .01). Steroid exposure reduced the adjusted odds of acute coronary syndrome by 82% (odds ratio [OR] 0.39; 95% confidence interval [CI], 0.20-0.74; adjusted OR 0.18; 95% CI, 0.06-0.51) in patients with inflammatory bowel disease, 77% in Crohn's disease (OR 0.36; 95% CI, 0.14-0.92; adjusted OR 0.23; 95% CI, 0.06-0.98), and 78% in ulcerative colitis (OR 0.41; 95% CI, 0.16-1.04; adjusted OR 0.22; 95% CI, 0.06-0.90). There was no association between other inflammatory bowel disease medications and acute coronary syndrome. CONCLUSIONS: In patients with inflammatory bowel disease, steroid use significantly reduces the odds of acute coronary syndrome. These findings provide further mechanistic insight into the inflammatory processes involved in inflammatory bowel disease and acute coronary syndrome.
BACKGROUND:Steroids are anti-inflammatory agents commonly used to treat inflammatory bowel disease. Inflammation plays a critical role in the pathophysiology of both inflammatory bowel disease and acute coronary syndrome. We examined the relationship between steroid use in patients with inflammatory bowel disease and acute coronary syndrome. METHODS: In 177 patients with inflammatory bowel disease (mean age 67 years, 75% male, 44% Crohn's disease, 56% ulcerative colitis), we performed a 1:2 case-control study matched for age, sex, and inflammatory bowel disease type, and compared 59 patients with inflammatory bowel disease with acute coronary syndrome to 118 patients with inflammatory bowel disease without acute coronary syndrome. Steroid use was defined as current or prior exposure. Acute coronary syndrome was defined as myocardial infarction or unstable angina, confirmed by cardiac biomarkers and coronary angiography. RESULTS: In patients with inflammatory bowel disease, 34% with acute coronary syndrome had exposure to steroids, vs 58% without acute coronary syndrome (P < .01). Steroid exposure reduced the adjusted odds of acute coronary syndrome by 82% (odds ratio [OR] 0.39; 95% confidence interval [CI], 0.20-0.74; adjusted OR 0.18; 95% CI, 0.06-0.51) in patients with inflammatory bowel disease, 77% in Crohn's disease (OR 0.36; 95% CI, 0.14-0.92; adjusted OR 0.23; 95% CI, 0.06-0.98), and 78% in ulcerative colitis (OR 0.41; 95% CI, 0.16-1.04; adjusted OR 0.22; 95% CI, 0.06-0.90). There was no association between other inflammatory bowel disease medications and acute coronary syndrome. CONCLUSIONS: In patients with inflammatory bowel disease, steroid use significantly reduces the odds of acute coronary syndrome. These findings provide further mechanistic insight into the inflammatory processes involved in inflammatory bowel disease and acute coronary syndrome.
Authors: Johanna Haapamäki; Risto P Roine; Ulla Turunen; Martti A Färkkilä; Perttu E T Arkkila Journal: J Crohns Colitis Date: 2010-10-30 Impact factor: 9.071
Authors: W Koenig; M Sund; M Fröhlich; H G Fischer; H Löwel; A Döring; W L Hutchinson; M B Pepys Journal: Circulation Date: 1999-01-19 Impact factor: 29.690
Authors: Mark T Osterman; Yu-Xiao Yang; Colleen Brensinger; Kimberly A Forde; Gary R Lichtenstein; James D Lewis Journal: Clin Gastroenterol Hepatol Date: 2011-07-13 Impact factor: 11.382
Authors: Andres J Yarur; Amar R Deshpande; David M Pechman; Leonardo Tamariz; Maria T Abreu; Daniel A Sussman Journal: Am J Gastroenterol Date: 2011-03-08 Impact factor: 10.864
Authors: Edward L Barnes; Renee M Beery; Allison R Schulman; Ellen P McCarthy; Joshua R Korzenik; Rachel W Winter Journal: Inflamm Bowel Dis Date: 2016-09 Impact factor: 5.325