Published: 15-06-2023 17:20 | Updated: 15-06-2023 22:08

IBD patients at increased risk of stroke, especially ischaemic events

In a nationwide Swedish study of more than 85,000 patients with biopsy-confirmed inflammatory bowel disease (IBD), researchers from Karolinska Institutet and Örebro University (Sweden) observed that IBD patients had an increased risk of stroke, especially of ischaemic events, compared to the general population. The results are published in Neurology.

Jiangwei Sun
Jiangwei Sun, postdoc at Karolinska Institutet. Photo: Lin Li

IBD is a chronic intestinal disease with a relapsing-remitting manner, including Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified. Previous studies have suggested that IBD patients are at an increased risk of thromboembolic events, but evidence on the long-term risk of stroke remains scarce. Moreover, in a recent postmarketing safety study on tofacitinib, a new drug approved for IBD treatment, an increased risk of stroke was observed in patients using this particular medication.

The researchers conducted a cohort study by linking a nationwide histopathology cohort (i.e., the ESPRESSO study) to several national healthcare registers in Sweden to explore whether patients with a biopsy-confirmed IBD had an increased long-term risk of stroke, compared to the general population and their IBD-free full siblings.

Portrait photo of Professor Jonas Ludvigsson in front of Aula Medica at Karolinska Institutet
Professor Jonas Ludvigsson. Photo: Alexander Donka.

During an average follow-up of 12 years, 3,720 of the people with IBD had a stroke, compared with 15,599 of the people who did not have IBD, which is a rate of 32.6 per 10,000 person years for those with IBD compared to 27.7 for those without IBD. Person-years represent both the number of people in the study and the amount of time each person spends in the study. When researchers accounted for other factors that could affect stroke risk, such as heart disease, high blood pressure and obesity, they found that people with IBD were 13% more likely to have a stroke than those without IBD.The risk remained increased even 25 years after IBD diagnosis, corresponding to one additional stroke case per 93 IBD patients. The excess risk was mainly driven by ischaemic stroke rather than hemorrhagic stroke.

The risk for ischaemic stroke was significantly increased across all IBD subtypes (i.e., CD, UC, and IBD-U). Sibling comparison analyses confirmed the main findings, suggesting the excess risk of stroke may be independent of familial factors.

Clinical implications

“Due to the excess risk of stroke in IBD patients, screening and management of traditional stroke risk factors in IBD patients could be more urgent to prevent fatal CVD complications”, says first author Jiangwei Sun, postdoc at the Department of Medical Epidemiology and Biostatistics.

“These findings highlight the need for clinical vigilance about the long-term excess risk of cerebrovascular events in IBD patients”, adds last author Jonas F Ludvigsson, professor at Karolinska Institutet and pediatrician at Örebro University Hospital.

This study was supported by FORTE.


Long-term Risk of Stroke in Patients With Inflammatory Bowel Disease: A Population-Based, Sibling-Controlled Cohort Study, 1969-2019.
Sun J, Halfvarson J, Appelros P, Bergman D, Ebrahimi F, Roelstraete B, Olén O, Ludvigsson J
Neurology 2023 Jun;():