Status were included as time-dependent variables. Subjects lost to GDC-0994 follow-up due to emigration from Denmark were censored at time of emigration. To address potential differences in risk of cardiovascular disease in patients with CD, UC or unspecified IBD we evaluated overall risk and disease activity related risk for each endpoint in an IBD subtype-stratified analysis. In addition, we changed the flare duration to assess the potential impact of flare-definition on the risk estimates. We did subgroup analyses 25033180 of patients that received anti-TNF agents (BHJ18A) and other immunomodulators including 6-mercaptopurine (L01BA01), azathioprine (L01BB02), and/or methotrexate (L04AX). We also did a subgroup analysis where we evaluated the influence of nine predefined risk factors (prior venous thromboembolism, heart failure, cardiac arrhythmias, chronic obstructive pulmonary disease [COPD], renal disease, hypertension, diabetes, and use of loop diuretics, lipid-lowering agents, and vitamin K antagonists) and stratified all IBD patients in groups of 0 (reference group), 1? or 3 risk factors. SAS version 9.2 and Stata version 11.1 were used for statistical analyses. Risk set matching was performed with Greedy matching macro (last accessed 5 September 2012 at http://mayoresearch.mayo.edu/mayo/research/biostat/upload/ gmatch.sas). We tested model assumptions, including the linearity of continuous variables and absence of interactions, and found them to be valid unless otherwise specified. Evaluation of the significance of an unmeasured confounder was made using the “rule out” approach for all reported results [22].EthicsRegister-based studies do not require ethical approval in Denmark as individual patients cannot be identified from the encrypted data that are available. The Danish Data protection agency Fosamprenavir (Calcium Salt) approved the study (reference no. 2007-58-0015, international reference: GEH-2010-001).ResultsA total of 26,293 IBD patients were identified with in the study period. After exclusion of patients with prior IBD, MI or stroke, the final study population included 20,795 patients (Fig. 2). A total of 199,978 matched controls were enrolled in the study. Patient characteristics at index are displayed in Table 1. The mean age of the study population was 43.8 (SD 18.7) years, and 54.5 were women. Loss to follow-up due to emigration was 2.0 among the included IBD cases and 3.5 among controls. The frequencies of co-morbidities were significantly higher among IBD patients compared to the matched controls, and use of cardiovascular drugs and glucose-lowering agents at baseline was significantly higher in the IBD group. Distribution of IBD disease activity is shown in table 2. We observed a total of 365 MIs, 454 strokes and 778 cardiovascular deaths in the IBD cohort as compared to 2,389 MIs, 3,327 strokes and 4,738 cardiovascular deaths in the matched control group during follow-up. IRs for MI were 2.93 (95 CI 2.64?.24) and 1.95 (1.87?.03) per 1000 person-years for IBD patients and matched controls. The risk of MI was increased both in unadjusted and adjusted analyses, with an adjusted overall risk of RR 1.17 (1.05?.31). During flares RR was 1.49 (1.16?.93) and during persistent activity the RR was 2.05 (1.58?.65) (Fig. 3 and Table 3). During remission the RR for MI was not increased (1.01 [0.89?.15]) and it was significantlyActive IBD and Risk of Atherothrombotic DiseaseFigure 2. Flowchart for the study population, IBD: Inflammatory bowel disease. doi.Status were included as time-dependent variables. Subjects lost to follow-up due to emigration from Denmark were censored at time of emigration. To address potential differences in risk of cardiovascular disease in patients with CD, UC or unspecified IBD we evaluated overall risk and disease activity related risk for each endpoint in an IBD subtype-stratified analysis. In addition, we changed the flare duration to assess the potential impact of flare-definition on the risk estimates. We did subgroup analyses 25033180 of patients that received anti-TNF agents (BHJ18A) and other immunomodulators including 6-mercaptopurine (L01BA01), azathioprine (L01BB02), and/or methotrexate (L04AX). We also did a subgroup analysis where we evaluated the influence of nine predefined risk factors (prior venous thromboembolism, heart failure, cardiac arrhythmias, chronic obstructive pulmonary disease [COPD], renal disease, hypertension, diabetes, and use of loop diuretics, lipid-lowering agents, and vitamin K antagonists) and stratified all IBD patients in groups of 0 (reference group), 1? or 3 risk factors. SAS version 9.2 and Stata version 11.1 were used for statistical analyses. Risk set matching was performed with Greedy matching macro (last accessed 5 September 2012 at http://mayoresearch.mayo.edu/mayo/research/biostat/upload/ gmatch.sas). We tested model assumptions, including the linearity of continuous variables and absence of interactions, and found them to be valid unless otherwise specified. Evaluation of the significance of an unmeasured confounder was made using the “rule out” approach for all reported results [22].EthicsRegister-based studies do not require ethical approval in Denmark as individual patients cannot be identified from the encrypted data that are available. The Danish Data protection agency approved the study (reference no. 2007-58-0015, international reference: GEH-2010-001).ResultsA total of 26,293 IBD patients were identified with in the study period. After exclusion of patients with prior IBD, MI or stroke, the final study population included 20,795 patients (Fig. 2). A total of 199,978 matched controls were enrolled in the study. Patient characteristics at index are displayed in Table 1. The mean age of the study population was 43.8 (SD 18.7) years, and 54.5 were women. Loss to follow-up due to emigration was 2.0 among the included IBD cases and 3.5 among controls. The frequencies of co-morbidities were significantly higher among IBD patients compared to the matched controls, and use of cardiovascular drugs and glucose-lowering agents at baseline was significantly higher in the IBD group. Distribution of IBD disease activity is shown in table 2. We observed a total of 365 MIs, 454 strokes and 778 cardiovascular deaths in the IBD cohort as compared to 2,389 MIs, 3,327 strokes and 4,738 cardiovascular deaths in the matched control group during follow-up. IRs for MI were 2.93 (95 CI 2.64?.24) and 1.95 (1.87?.03) per 1000 person-years for IBD patients and matched controls. The risk of MI was increased both in unadjusted and adjusted analyses, with an adjusted overall risk of RR 1.17 (1.05?.31). During flares RR was 1.49 (1.16?.93) and during persistent activity the RR was 2.05 (1.58?.65) (Fig. 3 and Table 3). During remission the RR for MI was not increased (1.01 [0.89?.15]) and it was significantlyActive IBD and Risk of Atherothrombotic DiseaseFigure 2. Flowchart for the study population, IBD: Inflammatory bowel disease. doi.
