Low Diastolic BP and Polypharmacy Increase Ischemic Colitis Risk in Older Women: Study
Prospective data from over 100,000 participants in the Women's Health Initiative show that the risk of ischemic colitis (IC) is higher among older women with low diastolic blood pressure and those taking two or more antihypertensive medications. IC was also found to be twice as common in women with a history of cardiovascular disease compared with those without. In contrast, higher dietary fiber intake appeared to have a protective effect, suggesting a potential role for dietary modification in reducing IC risk. The study was published in The American Journal of Gastroenterology by Wassertheil and colleagues.
Ischemic colitis (IC) is a major cause of morbidity and mortality in the elderly population, women more commonly being affected. Yet there is scarcity of data regarding both nonmodifiable as well as modifiable risk factors in the general population. This prospective study aimed to recruit 100,825 postmenopausal women of various ethnic and race descriptions from the Women’s Health Initiative study to collect demographic data, co-morbidities, cardiovascular risk factors, medication regimens, biochemical markers of various conditions, as well as psychosocial data on diet intake for a duration of 13.1 years.
To identify predictors of incident ischemic colitis, authors used domain-wide Lasso Cox regression to screen important variables. Then, they applied a multivariable Cox proportional hazards model to assess adjusted hazard ratios along with their corresponding 95% confidence intervals. Authors also investigated post-IC outcomes such as all-cause mortality within 30 days of hospitalization and causes of death.
Key findings
• The case incidence rate of 55.7 per 10,000 person-years occurred among women with a history of cardiovascular diseases compared with 27.3 events among 10,000 person-years among women without the history.
• Women with diastolic blood pressure less than 90 mmHg were also more likely to develop the condition.
• Using two or more types of drugs for the treatment of hypertension showed a 62% higher risk compared with the risk among non-users: aHR 1.62 (95% CI: 1.47 – 1.78).
• The burden of gastrointestinal symptoms may have contributed to this.
• The risk in those in the highest quartile of gastrointestinal symptoms was 31% higher than that in those in the lowest quartile (aHR 1.31; 95% CI: 1.20-1.42).
• Conversely, dietary fiber consumption was found to be a protective factor. For every 10 g/d increase in fiber consumed, there was a 7% reduction in the incidence of ischemic colitis (aHR: 0.93; 95 percent CI: 0.89 to 0.97).
• There was also a significant racial effect; Black women had a significantly lower adjusted HR for ischemic colitis than White women (aHR: 0.73; 95 percent CI: 0.63 to 0.83).
• The rate of 30-d mortality from any cause after an IC event was 10.6 percent.
This large prospective study confirmed that ischemic colitis in older women is strongly associated with cardiovascular disease, low diastolic blood pressure, and multiclass antihypertensive therapy, whereas higher intake of dietary fiber is protective. The results emphasize personalized blood pressure management and dietary counseling for the reduction of ischemic colitis risk and improvement of outcomes in this susceptible population.
Reference:
Wassertheil-Smoller, Sylvia PhD1; Larson, Joseph C. MS2; Xue, Xionan PhD1; Greywoode, Ruby MD3; Bohm, Michael MD4; Liu, Longjian MD5; Wallace, Robert MD6; Wactawski-Wende, Jean PhD7; Haring, Bernhard MD8,*; LaMonte, Michael PhD7,*. Low Diastolic Blood Pressure and Risk of Ischemic Colitis in the Women's Health Initiative Cohort. The American Journal of Gastroenterology ():10.14309/ajg.0000000000003878, December 09, 2025. | DOI: 10.14309/ajg.0000000000003878
