Patients With IBD at Increased Risk for Myocarditis

TOPLINE:

Patients with inflammatory bowel disease (IBD) have a higher risk for myocarditis, especially severe myocarditis, than the general population, even 20 years after diagnosis, although absolute risks are low.

METHODOLOGY:

• Prior studies suggest that patients with IBD have an increased risk for infections and inflammation, potentially increasing the risk for myocarditis.
• Researchers assessed the long-term myocarditis risk in patients with IBD from the Swedish National Patient Register and the ESPRESSO study including 24,738 patients with Crohn’s disease, 46,409 patients with ulcerative colitis, and 12,117 patients with unclassified IBD.
• The study included a population-matched cohort of 391,344 individuals from the general population as a reference and a sibling-controlled cohort of 96,149 full siblings without IBD for 53,149 patients with IBD.
• The primary outcome was incident myocarditis. The secondary outcome was severe myocarditis, defined as heart failure, death, or readmission to the hospital.
• The median follow-up was 12 years, and 21.1% of patients were followed for at least 20 years.

TAKEAWAY:

• Patients with IBD had a 50% increased risk of developing myocarditis that persisted up to 20 years after diagnosis and were 150% more likely to suffer from severe myocarditis.
• Absolute risks were relatively low, with 256 patients with IBD and 710 reference individuals being diagnosed with myocarditis (incidence rate, 22.6/100,000 person-years and 12.9/100,000 person-years, respectively).
• Patients with Crohn’s disease had a 48% increased risk for myocarditis and a 139% increased risk for severe myocarditis, whereas patients with ulcerative colitis were at a 58% and 182% increased risk, respectively.
• Patients with unclassified IBD were at a 214% increased risk for severe myocarditis.
• Compared with their full siblings, patients with IBD showed a 50% higher risk for myocarditis and a 107% increased risk for severe myocarditis.
• Subgroup analyses showed a stronger association with increased risk for myocarditis in patients with colonic Crohn’s disease, young males, and patients with hospital-treated viral infections.

IN PRACTICE:

“Although the low absolute risk of myocarditis argued against regular serological screening in patients with IBD for viruses that are inducers for myocarditis, our findings supported the preventive measures in current guidelines,” including vaccinations against myocarditis-associated viruses, serological profiling of these viruses, and monitoring immunocompromised patients with IBD, the authors wrote.

SOURCE:

The study, led by Jiangwei Sun, PhD, of Karolinska Institutet, Stockholm, Sweden, was published online in The American Journal of Gastroenterology.

LIMITATIONS:

Some individuals with myocarditis may have been misclassified owing to incomplete reporting of outpatient or inpatient care and the exclusion of mild cases. Certain confounding factors may not have been considered. Potential influences of disease activity and severity and IBD medications were not addressed. In addition, the study is observational and cannot determine a causal relationship between IBD and myocarditis.

DISCLOSURES:

The study was supported by the European Crohn’s and Colitis Organization, the Stiftelsen Professor Nanna Svartz fond, FORTE, and the Swedish Research Council. Some authors declared serving as speakers or on advisory boards or receiving grants or financial support outside of this work.