Objectives:

Data suggest atherosclerotic-related inflammation may play a role in the pathogenesis of inflammatory bowel disease (IBD), but large-scale studies are missing.

Methods:

In this nationwide case-control study, we used the Swedish Patient Register and the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort to identify adult cases of incident IBD between 2002-2021, with each case matched to up to 10 general population controls. We used conditional logistic regression to calculate odds ratios (ORs) for exposure to an atherosclerotic-related condition (myocardial infarction, thromboembolic stroke, or atherosclerosis itself) prior to being diagnosed with IBD.

Results:

There were a total of 56,212 individuals with IBD, and 531,014 controls. Of these 2,334 (4.2%) cases and 18,222 (3.4%) controls had a prior diagnosis of an atherosclerotic-related condition, corresponding to an OR of 1.30 (95% CI 1.24-1.37). Results were statistically significant for both Crohn’s disease (OR 1.37, 95% CI 1.26-1.48) and ulcerative colitis (OR 1.27, 95% CI 1.20-1.35), as well as for individuals who developed IBD at 40-59 and≥ 60 years-old. Additionally, associations persisted when adjusting for underlying comorbidities, including presence of immune-mediated diseases, as well as prior aspirin and/or statin use. The highest odds of an atherosclerotic-related condition were seen in the 6-12 months prior to IBD diagnosis, though odds were increased even≥ 5 years prior. A higher magnitude of odds was also observed when having two or more atherosclerotic-related conditions as compared to only one.

Conclusions:

A history of an atherosclerotic-related condition is associated with increased odds of developing IBD, particularly among older adults. Future studies should investigate whether drugs targeting atherosclerotic-related inflammation may prevent IBD in higher-risk individuals.