P0757 - Non-Alcoholic Fatty Liver Disease Adds to the Cardiovascular Risk of Inflammatory Bowel Disease: A Fact or Myth? A US Cohort Propensity Matched Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Aakriti Soni, MD

Saint Vincent Hospital
Worcester, MA

Aakriti Soni, MD¹, Aakash Desai, MD², Gursimran S. Kochhar, MD³, George M. Abraham, MD, MPH¹, Nisheet Waghray, MD⁴
¹Saint Vincent Hospital, Worcester, MA; ²MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; ³Allegheny Health Network, Pittsburgh, PA; ⁴Case Western Reserve University/Metro Health, Cleveland, OH

Introduction: Patients with inflammatory bowel disease (IBD) have an increased likelihood of developing non-alcoholic fatty liver disease (NAFLD) by almost 4.5 times. NAFLD is also independently associated with endothelial dysfunction, increased carotid intimal thickness, and the number of plaques in carotid and coronary arteries. The primary aim of our study was to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with co-existing IBD and NAFLD.

Methods: We conducted a retrospective cohort study to compare the 5-year risk of incident ischemic heart disease (IHD), heart failure (HF), cerebrovascular accident (CVA) and peripheral arterial disease (PAD), in patients with IBD between NAFLD and non-NAFLD cohort using TriNetX, a multi-institutional database. Patients with alcohol-related disorders, other chronic liver disease and cirrhosis were excluded from the study. A propensity score matching was performed for age, gender, race, known risk factors of ASCVD and IBD-related medications. Kaplan-Meier survival curves for all-cause mortality were generated between NAFLD and non-NAFLD cohorts with IHD after propensity score matching.

Results: A total of 3,046 patients with IBD developed NAFLD, of which 790 patients (26%) developed ASCVD (mean age 59.2 +/- 13 years old, 59% female, 85% Caucasian). After propensity score matching, there was no difference in the risk of IHD (adjusted OR [aOR] 1.05, 95% CI 0.87-1.27), ST-elevation myocardial infarction (aOR 0.79, 0.48-1.29), non-ST elevation myocardial infarction (aOR 0.74, 0.49-1.10), HF (aOR 0.85, 0.67-1.08), ischemic stroke (aOR 0.77, 0.57-1.05) and PAD (aOR 0.62, 0.28-1.37) between the NAFLD and non-NAFLD cohort. There was also no difference in the risk of ASCVD in sub-group analysis based on type of IBD (Table 1). There were 244 patients (8%) with non-alcoholic steatohepatitis (NASH) in the NAFLD cohort. There was no difference in the risk of a composite of ASCVD (1.06, 0.59-1.92) between NAFLD cohort with NASH and non-NAFLD cohort. The NAFLD cohort with IHD was not at a statistically significant higher risk of all-cause mortality (adjusted hazard ratio 1.21, 0.88-1.67) compared to the non-NAFLD cohort.

Discussion: Our study showed that patients with IBD and NAFLD are not at a higher risk of ASCVD compared to patients without NAFLD after matching for confounding variables. Healthcare providers caring for these patients should focus on tight disease control of IBD and aggressive risk factor modification of metabolic syndrome.

Figure: Figure 1: Kaplan-Meier survival curves for all-cause mortality for patients with IBD between NAFLD and non-NAFLD cohorts with IHD after propensity score matching.

Figure legend: aHR - adjusted hazard ratio; CI - confidence interval; NAFLD - non-alcoholic fatty liver disease; IHD - ischemic heart disease

ASCVD		N (%)	aOR	95% CI
IHD	IBD	247 (9.7%)	1.05	0.87 - 1.27
	UC	70 (10.5%)	1.02	0.70 - 1.44
	CD	113 (9.5%)	1.19	0.89 - 1.59

STEMI	IBD	29 (1.02%)	0.79	0.48 - 1.29
	UC	29 (1.02%)	0.90	0.39 - 2.07
	CD	10 (0.7%)	0.49	0.23 - 1.05

NSTEMI	IBD	43 (1.5%)	0.74	0.49 - 1.10
	UC	18 (2.3%)	1.11	0.56 - 2.19
	CD	15 (1.1%)	0.61	0.32 - 1.17

CVA	IBD	79 (2.8%)	0.77	0.57 - 1.05
	UC	19 (2.4%)	0.73	0.40 - 1.34
	CD	43 (3.2%)	1.08	0.70 - 1.69

HF	IBD	139 (5.1%)	0.85	0.67 - 1.08
	UC	46 (6.2%)	0.82	0.54 - 1.24
	CD	64 (5%)	0.91	0.64 - 1.29

PAD	IBD	10 (0.3%)*	0.62	0.28 - 1.37
	UC	10 (1.2%)*	0.99	0.41 - 2.40
	CD	10 (0.7%)*	0.76	0.33 - 1.75

Table: Risk of ASCVD in IBD and NAFLD cohort compared to IBD and non-NAFLD cohort expressed adjusted odds ratios (aOR) with 95% confidence intervals (CI)

Legend: ASCVD - atherosclerotic cardiovascular disease; IHD - ischemic heart disease; STEMI - ST-elevation myocardial infarction; NSTEMI - non-ST elevation myocardial infarction; HF - heart failure; CVA - cerebrovascular accident; PAD - peripheral artery disease; IBD- inflammatory bowel disease; UC - ulcerative colitis; CD - Crohn’s disease

*TriNetX obfuscates counts < 11 to maintain patient confidentiality.

Disclosures:

Aakriti Soni indicated no relevant financial relationships.

Aakash Desai indicated no relevant financial relationships.

Gursimran Kochhar: CorEvitas Research Foundation – Advisory Committee/Board Member. Digbi Health – Stock Options. GIE Medical – Advisory Committee/Board Member. Lilly Pharma – Advisory Committee/Board Member. Lilly Pharma – Speaker for Lilly Pharma. Pentax Endoscopy – Consultant.

George M. Abraham indicated no relevant financial relationships.

Nisheet Waghray indicated no relevant financial relationships.

Aakriti Soni, MD¹, Aakash Desai, MD², Gursimran S. Kochhar, MD³, George M. Abraham, MD, MPH¹, Nisheet Waghray, MD⁴. P0757 - Non-Alcoholic Fatty Liver Disease Adds to the Cardiovascular Risk of Inflammatory Bowel Disease: A Fact or Myth? A US Cohort Propensity Matched Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.