Association of diverticulitis and potential risk of ischemic stroke: population-based matched cohort study in Taiwan

Abstract

Background: Previous studies have suggested relationship between diverticular disease and cardiovascular disease. Since cardiovascular disease and cerebrovascular accident share a lot of pathogenesis, diverticulitis could also be a risk factor for stroke. This study tried to establish epidemiological evidence of the relationship between colon diverticulitis and ischemic stroke. Methods: In this retrospective cohort study, patients with newly diagnosed colon diverticulitis (N = 6238) and patients without colon diverticulitis (control group; N = 24 952) were recruited between January 1, 2000, and December 31, 2017. Both groups were matched by propensity score at a 1:4 ratio by age, sex, comorbidities and medications. Cox proportional hazard regression was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) of ischemic stroke. We also conducted 4 different regression models and 2 sensitivity analyses to test the robustness of our findings. Results: The diverticulitis group had a higher risk of IS than the control group (adjusted HR, 1.25; 95% CI, 1.12-1.39; P < 0.001). Serial sensitivity analyses yielded consistent positive link between diverticulitis and IS. Further subgroup analysis showed that in the study group, the risk of IS was 2.54-fold higher than the matched controls in 30-39 years. Conclusions: Our study found that colon diverticulitis was associated with a higher risk of developing subsequent ischemic stroke, especially for patients aged 30-39 years, among Asian population. This result provides us a chance to undertake preventive measures for ischemic stroke in high-risk patients. Key message: What is already known on this topic? Cardiovascular disease and cerebrovascular accident share a lot of pathogenesis. Previous studies have suggested relationship between diverticular disease and cardiovascular disease. What this study adds? Our study shows that diverticulitis was associated with higher risk of subsequent ischemic stroke, but not hemorrhagic stroke, especially for patients of younger age. The risk of ischemic stroke was 2.54-fold higher than the matched controls in 30-39 years. How this study might affect research, practice or policy? The risk of ischemic stroke in diverticulitis patients receiving colectomy seems to be ameliorated. Clinically, this gives us a chance to undertake preventive measures and reduce mortality and morbidity resulting from strokes in young adults.