Association between inflammatory bowel disease, current therapies, and cardiovascular events: a review and meta-analysis of data from 2.2 million individuals.

Objective: Inflammatory bowel disease (IBD) is associated with increased cardiovascular (CV) risk. Advanced therapies that treat IBD may modify this risk. Our systematic review and meta-analysis aim to investigate the association between IBD, its subtypes (Crohn's disease and ulcerative colitis) and its therapies, with CV disease.

Methods: Medline, Embase, Scopus, and Web of Science were searched from January 2000 to November 2023. Studies examining the relationship between IBD and the CV outcomes of incident myocardial infarction (MI), ischaemic heart disease (IHD), cerebrovascular accident (CVA) and major adverse cardiovascular events (MACE) were included. Pooled hazard ratios (HR) were calculated using inverse variance weighted random effects meta-analysis. Incidence rate differences for MACE were derived from studies comparing IBD therapies.

Results: Fourteen studies evaluating CV outcomes were included. Of the 2,232,375 individuals, 10.8% were IBD patients, mean age was 47.3 years and 48.4% were male. IBD was significantly associated with MI (HR 1.29, 95% CI: 1.07-1.56, I2 =0.87), IHD (HR 1.16, 95% CI: 1.01-1.33, I2=0.60), CVA (HR 1.15, 95% CI: 1.09-1.20, I2=0.30) and MACE (HR 1.19, 95% CI: 1.09-1.30, I2=0.81). Incidence rate differences (events per 1000 patient-years) for MACE, calculated for 16 comparative studies, ranged from 90.3 fewer events in tofacitinib compared with placebo to an excess of 17.9 events in a vedolizumab group compared with anti-TNFα biologics.

Conclusions: There is an increased risk of MI, IHD, CVA and MACE in IBD patients. Management of IBD needs to consider these risks and how it may be adjusted when selecting advanced therapies.