Inflammatory Bowel Disease Is Associated With an Increased Risk of Hospitalization for Heart Failure: A Danish Nationwide Cohort Study
Background—Inflammatory bowel disease (IBD) has been linked to adverse cardiovascular events, but a relation to heart failure is uncertain. We investigated the IBD-associated risk of heart failure in a nationwide setting.
Methods and Results—A total of 5,436,647 Danish citizens, with no history of IBD or heart failure, were included on 1 January 1997 and followed until first hospitalization for heart failure, death, or 31 December 2011. Of these subjects, 23,681 developed IBD for which disease activity was determined continuously throughout the study. The risk of hospitalization for heart failure was estimated with a Poisson regression model adjusting for comorbidity and cardiovascular pharmacotherapy as time-dependent covariates. During a mean follow-up of 11.8 years in the reference population and 6.4 years in the IBD group, hospitalization for heart failure occurred in 553 subjects with IBD, and 171,405 in the reference population. Patients with IBD had a 37% increased risk of hospitalization for heart failure (incidence rate ratio [IRR] 1.37, 95% confidence interval [CI] 1.26-1.49) compared to the reference population. IBD activity-specific analyses showed markedly increased risk of heart failure hospitalization during flares (IRR 2.54, 95% CI 2.13-3.04) and persistent activity (IRR 2.73, 95% CI 2.25-3.33]) but not in IBD remission (IRR 1.04, 95% CI 0.94-1.16).
Conclusions—In a nationwide cohort, IBD was associated with an increased risk of hospitalization for heart failure, and this risk was strongly correlated to periods of active disease. The mechanisms underlying this finding warrant further studies.
- Received January 29, 2014.
- Accepted July 10, 2014.