Dyslipidemia and lipoprotein profiles in patients with inflammatory bowel disease

Dyslipidemia is a major risk factor for developing coronary artery disease. An increase in inflammatory cytokines may result in a decrease in lipoprotein lipase (LPL) enzyme activity, leading to a characteristic lipoprotein profile with increased triglycerides and decreased high-density lipoprotein (HDL) levels as seen in patients with systemic lupus erythematosus (SLE). Similar to SLE, patients with IBD have high circulatory levels of inflammatory cytokines. However, in these patients characteristic lipoprotein profiles have not been reported.

The purpose of this study is to identify and describe dyslipidemia and lipoprotein profiles in an IBD patient population.

Medical records of patients diagnosed with IBD (Crohn's disease [CD] and ulcerative colitis [UC]) at an academic medical center between 2000 and 2007 were retrospectively reviewed for lipoprotein lipid measurements, serum albumin levels, risk factors, and treatment to modify lipoprotein concentrations. The lipoprotein guidelines and risk factors are based on the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Only patients with documented IBD diagnosis and lipoprotein profiles are included in the study. National Health and Nutrition Examination Survey (NHANES) 2005-2006 population database was used for control values.

A total of 393 patients (152 men and 241 women) diagnosed with IBD (188 CD and 205 UC) who were not on statins qualified for the study. Patients were grouped on the basis of gender (male and female) and IBD disease type (CD and UC). Compared with the male NHANES samples (with similar mean age and body mass index), total cholesterol and HDL-C were significantly lower and low-density lipoprotein cholesterol (LDL-C) and triglycerides were significantly greater in male patients with IBD. In female patients with IBD, the mean values for total cholesterol, HDL-C, and triglycerides were significantly lower and LDL-C significantly greater compared with the female NHANES samples.

Given low levels of HDL-C and increased levels of LDL-C, a more aggressive approach in profiling and treating dyslipidemia seems warranted in patients with IBD.