Original ArticleInflammatory bowel diseases increase future ischemic stroke risk: A Taiwanese population-based retrospective cohort study
Introduction
Stroke results in the sudden loss of neurological function caused by a disruption of blood flow to the brain. Previous studies have reported that stroke is the second leading cause of death worldwide [1], [2], [3]. In Taiwan, ischemic stroke is the major type of stroke [3], [4], which is similar to reports from the rest of the world. Stroke is also among the leading causes of disability in adults [5]. The identification of risk factors for stroke is crucial for the primary and secondary prevention of stroke.
The crucial role of inflammatory mechanisms in the progression of atherosclerosis has promoted many studies focusing on whether diseases characterized by chronic inflammation, including inflammatory bowel disease (IBD), carry an increased risk of cardiovascular disease [6], [7]. Numerous previous studies have reported an increased incidence of stroke and myocardial infarction (MI) in patients with rheumatoid arthritis, psoriasis, and systemic lupus erythematosus [8], [9], [10], but studies on the risk of atherothrombotic disease among patients with IBD are inconclusive [11], [12], [13], [14], [15]. However, recent evidence showed that IBD is associated with an increased risk of stroke and MI [16], [17].
IBD mainly comprises the following two chronic intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC) in addition to microscopic colitis. IBD affects approximately 1.4 million people in the United States [18] and approximately 2.2 million people in Europe [19]. Chuang et al. recently reported that IBD is still relatively uncommon in Taiwan, but the incidence and prevalence rates are increasing [20]. The linkage between IBD and atherothrombotic disease could have a substantial influence on patient management. Therefore, we conducted this nationwide population-based retrospective cohort study to assess the association between IBD and the risk of future ischemic stroke among adult patients in Taiwan. We hypothesize that IBD is associated with the development of acute ischemic stroke and collected the study data from Taiwan's National Health Insurance Research Database (NHIRD) among adult patients (≥ 20 years old).
Section snippets
Data sources
The National Health Insurance program has been implemented in Taiwan since 1995 and provides medical cover for approximately 99% of Taiwan's population (23.74 million people) [1]. The National Health Research Institutes (NHRI) of Taiwan established the National Health Insurance Research Database (NHIRD), which contains registration files and original claims data for reimbursement. The NHRI manages the annual claims data in the NHIRD and has established electronic datasets for administrative and
Results
The IBD and non-IBD cohorts comprised 18 392 and 7 3568 cases, respectively.
Among the study patients, 64.5% were younger than 50 years, and 54.9% were women (Table 1). The mean ages of the IBD and non-IBD cohorts were 44.8 ± 16.6 and 44.5 ± 16.8 years, respectively. Compared with the non-IBD cohort, the IBD cohort had a higher prevalence of hypertension (22.7% versus 19.0%, P < 0.001), diabetes (9.73% versus 8.11%, P < 0.001), CAD (12.2% versus 8.66%, P < 0.001), and cCHF (9.67% versus 7.80%, P <
Discussion
This study shows that the IBD cohort was at a 1.12-fold (95% CI, 1.02–1.23, Table 2) higher risk of developing subsequent ischemic stroke than the comparison cohort after adjusting for sex, age, and comorbidities. Comorbidities such as hypertension, diabetes, CAD, CHF, peripheral arterial disease, atrial fibrillation, and hyperlipidemia were significant factors associated with the occurrence of ischemic stroke. Compared with the UC patients in this study, the CD patients had a higher risk of
Author contribution
Wei-Shih Huang, Chun-Hung Tseng, and Chia-Hung Kao are responsible for the study design, coordination and drafted the manuscript. Cheng-Li Lin, Pei-Chun Chen, and Fung-Chang Sung collected data and performed analysis. Chon-Haw Tsai, Cheng-Li Lin, and Chia-Hung Kao provided some intellectual recommendation and reviewed the manuscript. Wei-Shih Huang, Chun-Hung Tseng, Cheng-Li Lin, and Chia-Hung Kao wrote the final version of the manuscript. All authors read and approved the final manuscript.
Conflicts of interests
All authors declare that there were no actual or potential conflicts of interest in this study.
Acknowledgment
This work was supported by the Aim for the Top University Plan of the National Chiao Tung University and Ministry of Education, Taiwan, R.O.C., National Science Council, Taiwan (NSC 99-2314-B-039-016-MY2), the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (DOH101-TD-B-111-004), Health and welfare surcharge of tobacco products, China Medical University Hospital Cancer Research Center of Excellence (MOHW103-TD-B-111-03, Taiwan), and the Tseng-Lien Lin
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Wei-Shih Huang and Chun-Hung Tseng contribute equally.