Background and Aims

Inflammatory diseases are associated with an increased risk of incident major adverse cardiovascular events (MACE). However, data on MACE are lacking in large population-based histopathology cohorts of microscopic colitis (MC).

Methods

This study included all Swedish adults with MC without previous cardiovascular disease (1990–2017; N = 11,018). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded intestinal histopathology reports from all pathology departments (n = 28) in Sweden. MC patients were matched for age, sex, calendar year, and county with up to 5 reference individuals (N = 48,371) without MC or cardiovascular disease. Sensitivity analyses included full sibling comparisons, and adjustment for cardiovascular medication and healthcare utilization. Multivariable-adjusted hazard ratios for MACE (any of ischemic heart disease, congestive heart failure, stroke, and cardiovascular mortality) were calculated using Cox proportional hazards modelling.

Results

Over a median of 6.6 years of follow-up, 2181 (19.8%) incident cases of MACE were confirmed in MC patients and 6661 (13.8%) in reference individuals. MC patients had a higher overall risk of MACE outcomes compared with reference individuals (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.21–1.33) and higher risk of its components: ischemic heart disease (aHR, 1.38; 95% CI, 1.28–1.48), congestive heart failure (aHR, 1.32; 95% CI, 1.22–1.43), and stroke (aHR, 1.12; 95% CI, 1.02–1.23) but not cardiovascular mortality (aHR, 1.07; 95% CI, 0.98–1.18). The results remained robust in the sensitivity analyses.

Conclusions

Compared with reference individuals, MC patients had a 27% higher risk of incident MACE, equal to 1 extra case of MACE for every 13 MC patients followed for 10 years.

中文翻译：

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显微镜下结肠炎患者发生主要不良心血管事件的风险较高：一项匹配队列研究

 背景和目标

炎症性疾病与重大不良心血管事件 (MACE) 风险增加相关。然而，基于大规模人群的显微结肠炎 (MC) 组织病理学队列中缺乏 MACE 数据。

 方法

这项研究纳入了所有患有 MC 且既往没有心血管疾病的瑞典成年人（1990-2017 年；N = 11,018）。 MC 和亚型（胶原性结肠炎和淋巴细胞性结肠炎）是根据瑞典所有病理科 (n = 28) 前瞻性记录的肠道组织病理学报告定义的。将 MC 患者的年龄、性别、日历年份和县与最多 5 名无 MC 或心血管疾病的参考个体 (N = 48,371) 进行匹配。敏感性分析包括完整的兄弟姐妹比较以及心血管药物和医疗保健利用的调整。使用 Cox 比例风险模型计算 MACE（任何缺血性心脏病、充血性心力衰竭、中风和心血管死亡率）的多变量调整风险比。

 结果

在中位 6.6 年的随访中，MC 患者中确认了 2181 例 (19.8%) 发生 MACE 的病例，参考个体中确认了 6661 例 (13.8%) 发生 MACE 的病例。与参考个体相比，MC 患者发生 MACE 结局的总体风险较高（调整后风险比 [aHR]，1.27；95% 置信区间 [CI]，1.21–1.33），其组成部分的风险较高：缺血性心脏病（aHR，1.38） ；95% CI，1.28–1.48）、充血性心力衰竭（aHR，1.32；95% CI，1.22–1.43）和卒中（aHR，1.12；95% CI，1.02–1.23），但不包括心血管死亡率（aHR，1.07） ；95% CI，0.98–1.18）。敏感性分析结果仍然稳健。

 结论

与参考个体相比，MC 患者发生 MACE 的风险高出 27%，相当于随访 10 年时每 13 名 MC 患者就会额外发生 1 例 MACE。