ACUTE CORONARY SYNDROME AND INFLAMMATORY BOWEL DISEASE: A 20-YEAR NATIONAL DATABASE STUDY ON CARDIOVASCULAR RISK AND INSIGHT INTO PREVENTION

Abstract

Therapeutic Area

ASCVD/CVD in Special Populations

Background

Patients with inflammatory bowel disease (IBD) are at an increased risk of developing acute coronary syndrome (ACS). This elevated risk is thought to stem from chronic systemic inflammation coupled with traditional risk factors for cardiovascular disease (CVD). Despite this recognized association, limited data exists on the impact of inflammation control and classic CVD preventive strategies in IBD.

Methods

We performed a retrospective analysis of a national database (TriNetX, LLC), accessed on February 19, 2025, encompassing electronic health records from 64 hospital systems and over 100 million patients across the United States between January 1, 2005, and January 1, 2025. Patients with IBD were compared to propensity-matched adult controls (matched for age, sex, hypertension, type 2 diabetes, dyslipidemia, tobacco use, alcohol abuse, and overweight/obesity) using 1:1 greedy nearest neighbor matching. Primary analysis compared the prevalence, odds ratio, and Cox proportional hazards regression for ACS in patients with IBD compared to propensity-matched controls. Subset analyses examined comorbidities, cardiovascular medication use, and IBD-specific immunomodulatory therapies in IBD patients with and without ACS.

Results

Among 185,881 IBD patients and 7,873,639 propensity-matched controls, the unweighted ACS prevalence was 10.6% vs. 6.6% (OR 1.68, 95% CI [1.65-1.71], p<0.001). The presence of IBD was independently associated with a greater risk of ACS over time (HR 1.33, 95% CI [1.311.35], p<0.001). Subset analyses yielded 19,775 patients with IBD who had ACS and 166,106 patients with IBD who did not have ACS. Between these two groups, the use of common immunomodulators was associated with a lower risk of ACS (OR 0.16, 95% CI [0.15-0.17], p <0.001). Traditional CVD risk factors remained prevalent among IBD patients, with no significant risk reduction observed with conventional cardiovascular medications; however, optimal dosing and degree of risk factor control could not be assessed.

Conclusions

From 2005 to 2025, ACS prevalence remained higher in IBD patients, mirroring prior studies. Our findings highlight the complex interplay between chronic systemic inflammation and classic CVD risk factors in driving ACS risk among IBD patients. While immunomodulatory therapy appears to be protective against CVD, comprehensive and aggressive strategies to manage traditional CVD risk factors remain essential.