World J Gastroenterol. 2019;25(22):2788-2798.

Increased risk of atrial fibrillation in patients with inflammatory bowel disease: A nationwide population-based study.

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제1저자 최유정 · 교신저자 최의근

PMID 31236001 PMC6580358 DOI 10.3748/wjg.v25.i22.2788 IF 7.7 순환기내과

소속 (4)

Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea. choiek17@snu.ac.kr.
Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 03083, South Korea.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, South Korea.

Abstract

BACKGROUND Inflammatory bowel disease (IBD), a chronic inflammatory disease of the gastrointestinal tract, could play a role in the pathophysiology of atrial fibrillation (AF).

AIM To investigate the association between IBD and AF development.

METHODS We performed a population-based cohort study using records in the Korean National Health Insurance Services database between 2010 and 2014. A total of 37696 patients with IBD (12349 with Crohn's disease and 25397 with ulcerative colitis) were identified. The incidence rate of newly diagnosed AF in patients with IBD was compared with that in a 3 times larger cohort of 113088 age- and sex-matched controls without IBD.

RESULTS During 4.9 ± 1.3 years of follow-up, 1120 patients newly diagnosed with AF (348 in the IBD group and 772 in controls) were identified. After adjustments using multivariable Cox proportional hazards, patients with IBD were at a 36% [95% confidence interval (CI) 20%-54%] higher risk of AF than controls. The association between IBD and the development of AF was stronger in younger than in older patients. Patients without cardiovascular risk factors showed a higher risk of AF primarily. Additionally, patients receiving immun-omodulators [Hazard ration (HR) 1.46, 95%CI 1.31-1.89], systemic corticosteroids (HR 1.37, 95%CI 1.10-1.71), or biologics agents (HR 2.38, 95%CI 1.51-3.75) were at higher risk of AF than patients without them.

CONCLUSION IBD significantly increased the risk of AF, and the impact of IBD on developing AF was in patients with moderate to severe disease.

Keywords

Atrial fibrillationColitis, UlcerativeCrohn’s diseaseInflammatory bowel disease

Figures

**Figure 1** Kaplan–Meier survival curves for cumulative incidence of atrial fibrillation. Cumulative incidence was defined as the probability of new-onset atrial fibrillation during follow-up. A: Comparison between inflammatory bowel disease (IBD) group and control group; B: Comparison between Crohn’s disease group and control group; C: Comparison between ulcerative colitis group and non-IBD group. CD: Crohn’s disease; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; AF: Atrial fibrillation.

**Figure 2** Subgroup analysis. Subgroup analysis to assess the risk of atrial fibrillation in patients with inflammatory bowel disease (IBD) based on age (< 30, 30-44, 45-59, and ≥ 60 years), sex (men and women), and cardiovascular (CV) risk factors (those with and without CV risk factors). The association between IBD and the risk of development of atrial fibrillation was weaker in older individuals and in those with CV risk factors. ¹Incidence rates have been calculated per 1000 patient-years; ²Adjusted for age, sex, location, income, diabetes mellitus, hypertension, dyslipidemia, stroke, myocardial infarction, venous thromboembolism, and end-stage renal disease; ³Hypertension, diabetes mellitus, or dyslipidemia. CI: Confidence interval; CV: Cardiovascular; HR: Hazard ratio; IBD: Inflammatory bowel disease.

그림 출처: PubMed Central 공개 논문 (PMC6580358)

Conflict of interest statement

Conflict-of-interest statement: We have no financial relationships to disclose.

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