S1794 Long-Term Heart Failure Risk Reduction in Inflammatory Bowel Disease: Biologic vs Non-Biologic Therapy

Introduction: Inflammatory bowel disease (IBD) is associated with systemic inflammation, increasing heart failure risk, particularly during flares. Biologic therapy may reduce this risk by controlling inflammation, yet limited research compares its impact to non-biologic therapies. This study evaluates whether biologic therapy reduces heart failure risk in IBD patients compared to non-biologic therapy over 1, 3, and 5 years. Methods: We obtained data from the TriNetX Research Network, including electronic medical records of 225,303 IBD patients from 94 healthcare organizations. We included adult patients (≥18 years) with Crohn’s disease or ulcerative colitis and excluded those with prior heart failure, arrhythmia, myocardial infarction, or stroke. Patients were divided into biologic and non-biologic therapy cohorts, and propensity score matching was performed to balance demographics, comorbidities, and disease severity. Final cohort sizes were 16,179 (1 year), 16,181 (3 years), and 15,821 (5 years). We used Kaplan-Meier survival analysis to evaluate heart failure-free survival probabilities and calculated hazard ratios (HRs) to compare risks. Results: At 5 years, biologic therapy significantly reduced heart failure risk compared to non-biologic therapy, with a risk difference of 0.22% (P < 0.0001). Risk differences were also significant at 3 years (0.25%, P < 0.0001) and 1 year (0.07%, P = 0.040). Kaplan-Meier survival analysis demonstrated higher heart failure-free survival probabilities in biologic-treated patients at all time points, with HRs (95% CI) of 2.09 (1.02-4.29) at 1 year, 3.39 (1.94-5.90) at 3 years, and 2.53 (1.53-4.17) at 5 years. Conclusion: Biologic therapy significantly reduces heart failure risk in IBD patients, with substantial benefits observed over 1, 3, and 5 years. These findings highlight the potential of biologic therapy to reduce cardiovascular complications in IBD, likely through inflammation control. Despite propensity score matching, the retrospective design limits causality. Prospective studies are needed to confirm these findings and explore mechanisms underlying the cardioprotective effects of biologics in IBD patients.