DOP134The risk of major adverse cardiovascular events in adult patients with Inflammatory Bowel Disease – A Danish nationwide cohort study 1996 - 2022

Background Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is associated with increased risks of thromboembolism and acute arterial events such as pulmonary embolism, stroke and ischemic heart disease.1 This study aimed to estimate the impact of disease activity on major adverse cardiovascular events (MACE) and whether different treatment regimens influence this risk. Methods We performed a nationwide, population-based, observational cohort study using Danish national registries. The study included all Danish patients diagnosed with IBD as adults without history of cancer or MACE upon inclusion. Patients were followed from January 1st, 1996 (or their date of diagnosis if after this date) until December 31st, 2022, emigration, MACE or death. Non-IBD controls (1:10) were matched by age, sex, and place of residence at the index date. Information about patient characteristics, biomarkers, and IBD-related medical and surgical treatment was obtained from the respective registries. Periods of active disease were defined by presence of elevated biomarkers, changes in IBD-related treatment, surgeries or hospitalisations. Descriptive analysis was performed on baseline characteristics and Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). Results We included a total of 50,530 patients with adult onset IBD, of which 16,164 were diagnosed with CD (32%). Overall, 4,049 (8.0%) patients experienced at least one MACE: 8.8% in UC (n = 3,038), and 6.3% in CD (n = 1,011). This corresponded to an overall aHR of 1.08 (95%CI 1.04-1.12) for MACE in patients with IBD compared to controls (Figure 1). The risk of MACE was increased in periods with active disease versus remission (aHR 3.23 (95CI% 3.02-3.47)). The risk also differed between treatment regimens when compared with periods without treatment (Figure 2). The risk of MACE was lower or similar to receiving no treatment for 5-aminosalicylic acid (5-ASA, aHR: 0.89 (0.81, 0.98)), immunomodulators (aHR 0.81 (0.65, 1.01)), and advanced therapies (aHR: 0.84 (0.64, 1.10)). In contrast, the risk of MACE was significantly increased when receiving corticosteroids (aHR 2.54 (2.23, 2.88)), and after IBD-related surgeries (aHR: 4.88 (3.82, 6.22)). Conclusion IBD is associated with an increased risk of MACE, strongly driven by periods of active disease. Corticosteroid exposure and recent surgery confer substantial additional risk, whereas 5-ASA, immunomodulators, and advanced therapies do not increase risk compared with untreated periods. These findings underscore the importance of achieving and maintaining disease control and minimizing corticosteroid use to reduce cardiovascular complications in IBD. Reference: 1. Olivera PA, Zuily S, Kotze PG, et al. International consensus on the prevention of venous and arterial thrombotic events in patients with inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2021;18:857–873. Conflict of interest: Brandi, Jens Wolfgang: No conflict of interest Wewer, Mads Damsgaard: Novo Nordisk Foundation, grant Bristol Myers Squibb, unrestricted grant Agerbo Modin, Frederikke: No conflict of interest Bendtsen, Flemming: Tillotts Burisch, Johan: Grant: Johnson & Johnson, MSD, Takeda, Tillots Pharma, BMS, Novo Nordisk Personal Fees: Celgene, MSD, Pfizer, AbbVie, Takeda, Tillots Pharma, Samsung Bioepis, BMS, Pharmacosmos, Galapagos, Zealand Pharma, Orion Pharma, Ferring, Johnson & Johnson