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Patients diagnosed with inflammatory bowel disease (IBD) face a heightened risk of developing myocarditis, particularly severe cases, compared to the general population, according to a recent study published in The American Journal of Gastroenterology.
The research, led by Dr. Jiangwei Sun of the Karolinska Institutet in Stockholm, Sweden, delved into the long-term myocarditis risk among individuals with IBD. Drawing from the Swedish National Patient Register and the ESPRESSO study, the investigation involved a comprehensive analysis of 24,738 Crohn’s disease patients, 46,409 ulcerative colitis patients, and 12,117 patients with unclassified IBD.
Key findings from the study revealed that patients with IBD exhibited a 50% increased risk of developing myocarditis, a risk that persisted up to 20 years post-diagnosis. Furthermore, the likelihood of severe myocarditis, defined by complications such as heart failure, death, or hospital readmission, was 150% higher among individuals with IBD.
Despite these concerning statistics, the absolute risks remained relatively low. Out of 256 patients with IBD diagnosed with myocarditis, the incidence rate stood at 22.6 per 100,000 person-years, compared to 12.9 per 100,000 person-years among the general population.
Distinctions were observed among different types of IBD. Patients with Crohn’s disease faced a 48% increased risk of myocarditis and a 139% increased risk of severe myocarditis. Similarly, those with ulcerative colitis experienced a 58% and 182% elevated risk, respectively. Meanwhile, patients with unclassified IBD were at a staggering 214% increased risk of severe myocarditis.
The study also compared patients with IBD to their full siblings without the condition. Even in this controlled cohort, individuals with IBD exhibited a 50% higher risk of myocarditis and a 107% increased risk of severe myocarditis.
Notable factors associated with heightened myocarditis risk in IBD patients included colonic Crohn’s disease, young male demographics, and a history of hospital-treated viral infections.
In response to these findings, the authors advocated for preventive measures outlined in existing guidelines, including vaccinations against myocarditis-associated viruses, serological profiling, and regular monitoring of immunocompromised patients with IBD.
Despite the robustness of the study, several limitations were acknowledged. These included potential misclassification of myocarditis cases, incomplete reporting, unaccounted confounding factors, and the observational nature of the study, which precludes establishing a causal relationship between IBD and myocarditis.
The study received support from various organizations, including the European Crohn’s and Colitis Organization, the Stiftelsen Professor Nanna Svartz fond, FORTE, and the Swedish Research Council. Some authors disclosed involvement in activities such as serving as speakers or advisory board members, or receiving grants outside of this work.
As research continues to illuminate the intricate relationship between IBD and cardiovascular health, the study underscores the importance of tailored monitoring and preventive strategies to safeguard the well-being of patients grappling with these conditions.
