S1797 Cardiovascular Outcomes of Biologics vs Non-Biologics Therapy in Inflammatory Bowel Disease: A Propensity-Matched Cohort Analysis

Introduction: Inflammatory bowel disease (IBD) increases the risk of cardiovascular (CV) complications, including myocardial infarction (MI), stroke, heart failure, and arrhythmia, especially during flares. Effective treatment may reduce CV risk, but data comparing biologic vs non-biologic therapies are limited. This study evaluates the impact of therapy type on CV risk in IBD over 1, 3, and 5 years. Methods: Using the TriNetX Research Network, we analyzed 225,303 IBD patients from 94 healthcare organizations. Adults (≥18 years) with Crohn’s disease or ulcerative colitis and no prior MI, stroke, heart failure, or significant arrhythmia were included. Patients were stratified into biologic and non-biologic cohorts and propensity score-matched for demographics, comorbidities, and disease severity, yielding balanced groups at 1 year (N = 16,179), 3 years (N = 16,181), and 5 years (N = 15,821). Primary outcomes included incidence of stroke, MI, heart failure, and arrhythmias. Kaplan-Meier analysis estimated event-free survival, and hazard ratios with 95% confidence intervals were calculated. Results: At 5 years, biologics reduced MI risk by 0.18% (P < 0.0001), stroke by 0.12% (P = 0.002), heart failure by 0.22% (P < 0.0001), and arrhythmia by 0.91% (P < 0.0001), with significantly higher event-free survival probabilities. Conclusion: Biologic therapy is associated with significant reductions in cardiovascular events, including myocardial infarction, stroke, heart failure, and arrhythmias, over 5 years in IBD patients. These findings highlight the potential cardioprotective effects of biologics, likely through the reduction of systemic inflammation which is a known contributor to cardiovascular risk. While these results emphasize the importance of incorporating biologics into IBD management, prospective studies are needed to confirm causality and explore the underlying mechanisms driving these benefits.