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
ARTICLE HIGHLIGHTS
Research background

Systemic inflammatory disease is known to increase the risk of cardiovascular diseases such as stroke, myocardial infarction, and atherosclerosis. Also, it has recently emerged as a risk factor for atrial fibrillation (AF). Inflammatory bowel disease (IBD) is a chronic progressive inflammatory disease, which can affect the gastrointestinal tract. Considering that pathogenesis of AF is linked to systemic inflammation, IBD might be a potential risk factor for AF de-velopment.

Research motivation

Recently, the incidence and prevalence of IBD have increased in the young Asian population. The impact of IBD on cardiovascular disease is an important issue. Therefore, we need to clarify the relationship between IBD and AF development in the Asian population and young patients

Research objectives

We aimed to investigate the association between IBD and AF development in Asians.

Research methods

We performed a population-based cohort study using the certified claim database form the Koran National Health Insurance Services between 2010 and 2014. The special codes of the rare and intractable disease program were used to define the patient, which include the complete medical history of patients. A total of 37696 patients with IBD (12349 with Crohn’s disease and 25397 with ulcerative colitis) were identified. The primary endpoint was new-onset AF, which occurred among IBD patients without a previous history of AF during the follow-up period. AF was defined using the International Classification of Disease, Tenth Revision, Clinical Modification codes (I480-I484, I489).

Research 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). IBD patients had a 36% (95% confidence interval 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, and in patients without cardiovascular risk factors. Additionally, moderate-severe IBD patients, who received immunomodulators, systemic corticosteroids, or biologics agents were at higher risk of AF. These findings supported that systemic inflammatory disease could be an independent risk factor for AF development. However, further studies on the impact of other systemic inflammation on AF need to be performed to provide conclusive evidence.

Research conclusions

IBD, chronic systemic disease, significantly increase the risk of AF development in Asians, as similar to the Western population. Moreover, the impact of IBD on AF incident was higher in young patients and those without cardiovascular risk factors. Therefore, our findings supported that systemic inflammatory disease is an independent risk factor for AF, even in patients without classic cardiovascular risk factors.

Research perspectives

It is necessary to pay attention to the occurrence of cardiovascular diseases such as AF in patients with IBD, even in young age. In particular, a patient receiving immunomodulators, systemic corticosteroids, or biologics agents for moderate-severe disease, had a higher risk of AF development than those without.