C0017 - Chronic Pancreatitis and Risk of Atherosclerotic Cardiovascular Disease (ASCVD): A U.S. Cohort Propensity Matched Study

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Aakash Desai, MD

MetroHealth Medical Center/Case Western Reserve University
Cleveland, OH

Aakash Desai, MD¹, Saurabh Chandan, MD², Daryl Ramai, MD, MSc³, Vivek Kaul, MD, FACG⁴, Gursimran S. Kochhar, MD⁵
¹MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH; ²CHI Health Creighton University Medical Center, Omaha, NE; ³University of Utah, Salt Lake City, UT; ⁴University of Rochester Medical Center, Rochester, NY; ⁵Allegheny Health Network, Pittsburgh, PA

Introduction: The worldwide prevalence of chronic pancreatitis (CP) has continued to rise in recent years, with data suggesting increased risk of atherosclerotic cardiovascular disease (ASCVD) in these patients. The primary aim of our study was to assess the risk of ASCVD and outcomes of ischemic heart disease (IHD) in patients with CP.

Methods: We compared the risk of ischemic heart disease (IHD), cerebrovascular accident (CVA) and peripheral arterial disease (PAD) between CP and non-CP cohort after propensity matching of known risk factors of ASCVD using TriNetX, a multi-institutional database. We also evaluated the risk of outcomes of IHD including acute coronary syndrome (ACS), heart failure (HF), cardiac arrest and all-cause mortality between CP and non-CP cohort. Sub-group analysis was performed based on use of aspirin (ASA) or statin and severity of diabetes mellitus (DM) and chronic pancreatitis prior to the development of IHD.

Results: A total of 28,290 patients (mean age 65.7 +/- 17.3) were in the CP cohort. Cumulative incidence of IHD, CVA and PAD was 25.7%, 6.2% and 6.2% respectively. CP cohort was also found to have an increased risk for IHD (adjusted OR [aOR] 1.08, 95% CI 1.03 – 1.12), CVA (aOR 1.12, 1.05 – 1.20) and PAD (aOR 1.17, 1.1 – 1.24) compared to non-CP cohort after propensity-score matching. CP cohort with IHD was also found to have an increased risk for ACS (aOR 1.16, 1.04 – 1.30), cardiac arrest (aOR 1.24, 1.01 – 1.53) and mortality (aOR 1.60, 1.45 – 1.77) compared to non-CP cohort. Kaplan-Meier analysis revealed that patients in the CP cohort with IHD had poor survival probability in terms of all-cause mortality (log-rank test p < 0.0001) compared to non-CP cohort with IHD. CP cohort were still at an increased risk for mortality in spite of ASA (aOR 1.74, 1.50 – 2.01) or statin (aOR 1.47, 1.14 – 1.89) use before IHD. Severe CP cohort were at an increased risk for mortality (aOR 1.55, 1.18 – 2.04) compared to non-severe CP cohort.

Discussion: CP patients are at a higher risk for ASCVD when compared to the general population, matched for confounding etiological, pharmacological and comorbid variables. Routine healthcare maintenance should focus on cardiovascular risk assessment as well as timely diagnostic and therapeutic interventions.

Figure: Kaplan-Meier survival curves for all-cause mortality between CP and non-CP cohorts with IHD.

Medication	Outcome	Cohort	N (%)	OR (95% CI)

Aspirin	ACS	CP	455 (20.4)	1.31 (1.12 – 1.53)
		Non-CP	364 (16.3)
	HF	CP	766 (34.4)	1.01 (0.89 – 1.15)
		Non-CP	757 (34.0)
	Cardiac arrest	CP	92 (4.1)	1.45 (1.05 – 2.01)
		Non-CP	64 (2.8)
	Mortality	CP	578 (26.0)	1.74 (1.50 – 2.01)
		Non-CP	373 (16.7)

Statin	ACS	CP	158 (20)	1.24 (0.96 – 1.60)
		Non-CP	132 (16.7)
	HF	CP	264 (33.4)	1.07 (0.86 – 1.32)
		Non-CP	252 (31.8)
	Cardiac arrest	CP	30 (3.7)	1.07 (0.63 – 1.81)
		Non-CP	28 (3.5)
	Mortality	CP	178 (22.5)	1.47 (1.14 – 1.89)
		Non-CP	130 (16.4)

Insulin	ACS	CP	1094 (19.2)	0.99 (0.90 – 1.09)
		Non-CP	1097 (19.3)
	HF	CP	1893 (33.3)	0.83 (0.77 – 0.89)
		Non-CP	2133 (37.5)
	Cardiac arrest	CP	310 (5.4)	1.23 (1.04 – 1.46)
		Non-CP	254 (4.4)
	Mortality	CP	1547 (27.2)	1.40 (1.29 – 1.53)
		Non-CP	1194 (21.0)

Table: Outcomes of IHD between CP and non-CP cohort based on different medications prior to the development of IHD.

Disclosures:

Aakash Desai indicated no relevant financial relationships.

Saurabh Chandan indicated no relevant financial relationships.

Daryl Ramai indicated no relevant financial relationships.

Vivek Kaul: Ambu – Consultant. CDX – Consultant. Cook Medical – Consultant. Motus GI – Consultant. Steris Corp – Consultant.

Gursimran Kochhar: GIE Medical – Advisor or Review Panel Member. Lilly Pharma – Advisor or Review Panel Member.

Aakash Desai, MD¹, Saurabh Chandan, MD², Daryl Ramai, MD, MSc³, Vivek Kaul, MD, FACG⁴, Gursimran S. Kochhar, MD⁵. C0017 - Chronic Pancreatitis and Risk of Atherosclerotic Cardiovascular Disease (ASCVD): A U.S. Cohort Propensity Matched Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.