Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2019; 25(22): 2788-2798
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2788
Increased risk of atrial fibrillation in patients with inflammatory bowel disease: A nationwide population-based study
You-Jung Choi, Eue-Keun Choi, Kyung-Do Han, Jiesuck Park, Inki Moon, Euijae Lee, Won-Seok Choe, So-Ryoung Lee, Myung-Jin Cha, Woo-Hyun Lim, Seil Oh
You-Jung Choi, Eue-Keun Choi, Jiesuck Park, Inki Moon, Euijae Lee, Won-Seok Choe, So-Ryoung Lee, Myung-Jin Cha, Seil Oh, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
Kyung-Do Han, Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 03083, South Korea
Woo-Hyun Lim, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, South Korea
Author contributions: Choi YJ, Choi EK, Lee SR, Park J, Moon I, Choe W, Lee E, Lee SR, Cha MJ, Lim WH, and Oh S conceived of the presented idea, planned the study design, and contributed to the interpretation of the results; Choi YJ and Choi EK took the lead in writing the manuscripts; Han KD performed the analysis; all authors provided critical feedback and helped shape the research, analysis and manuscript.
Supported by: grant no 620174270 from the SNUH Research Fund.
Institutional review board statement: This study was exempt from review by the Seoul National University Hospital Institutional Review Board (E-1707-001-863).
Informed consent statement: This study is appropriate for IRB to approve a waiver to document informed consent
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eue-Keun Choi, MD, PhD, Associate Professor, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. choiek17@snu.ac.kr
Telephone: +82-2-2072-0688 Fax: +82-2-762-9662
Received: February 2, 2019
Peer-review started: February 6, 2019
First decision: February 21, 2019
Revised: April 22, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: June 14, 2019
Processing time: 134 Days and 10.5 Hours
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 fibrillation; Inflammatory bowel disease; Colitis, Ulcerative; Crohn’s disease

Core tip: Inflammatory bowel disease (IBD), a chronic inflammatory disease of the gastrointestinal tract, was strongly associated with an increased risk of atrial fibrillation (AF). Both Crohn’s disease (CD) and ulcerative colitis (UC) increase the risk of AF, with a higher risk in patients with CD than UC. And the impact of IBD on developing AF was stronger in patients receiving immunomodulators, systemic corticosteroids or biologics agents, which are prescribed for moderate-to-severe disease than patients without them. Therefore, physicians need to consider screening for AF in patients with IBD, particularly those who use more potent therapies.