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Evaluation of early atherosclerosis in patients with inflammatory bowel disease
Hasan Kayahan1, Ismail Sari, Nesat Cullu
1Department of Gastroenterology, School of Medicine, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey. kayahancup@gmail.com
Insights
Inflammatory bowel disease patients show impaired vascular function, indicated by reduced flow-mediated dilation, even before structural changes appear. Elevated soluble CD40 ligand suggests a higher risk of adverse vascular outcomes in inflammatory bowel disease.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Immunology
Background:
- Limited data exists on early atherosclerosis in inflammatory bowel disease (IBD).
- Conflicting results highlight the need for further investigation into vascular involvement in IBD.
Purpose of the Study:
- To assess subclinical vascular disease in IBD patients.
- To evaluate serological and sonographical markers of vascular function in IBD.
Main Methods:
- Sonographic assessment of brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT).
- Measurement of serum soluble CD40 ligand (sCD40L) levels.
- Comparison between 39 IBD patients (Crohn's disease and ulcerative colitis) and 31 healthy controls.
Main Results:
- IBD patients exhibited significantly impaired FMD compared to controls.
- Elevated erythrocyte sedimentation rate, C-reactive protein, and sCD40L were observed in IBD patients.
- sCD40L negatively correlated with FMD, and FMD was predicted by CRP and sCD40L levels.
Conclusions:
- Functional vascular changes, indicative of atherosclerosis, precede structural changes in IBD.
- Elevated sCD40L may predict poorer vascular outcomes in patients with inflammatory bowel disease.
Background:
Data regarding early atherosclerosis and inflammatory bowel disease are limited and conflicting results are present.
Aims:
The purpose of this study was to evaluate serological and sonographical evidence of subclinical vascular involvement in patients with inflammatory bowel disease.
Methods:
Thirty-nine patients with inflammatory bowel disease (20 Crohn's disease, and 19 ulcerative colitis patients) and 31 healthy controls were consecutively enrolled in the study. Flow mediated dilatation of the brachial artery and intima media thickness assessments of the common carotid artery were measured sonographically. Soluble CD40 ligand levels were evaluated. Crohn's disease activity index and modified Truelove-Witt's criteria were also noted.
Results:
Age, sex distribution, serum lipids, smoking status, and intima media thickness of the common carotid artery were similar between the inflammatory bowel disease patients and controls (p > 0.05). However, both endothelium dependent and independent flow mediated dilatation values were significantly impaired in the inflammatory bowel disease group compared with healthy controls (p < 0.05). Erythrocyte sedimentation rate, C-reactive protein and soluble CD40 ligand values were significantly increased in inflammatory bowel disease patients compared with controls (p < 0.05), and soluble CD40 ligand was negatively correlated with flow mediated dilatation (r = -0.3, p < 0.05). Flow mediated dilatation was significantly predicted from the concentrations of C-reactive protein and soluble CD40 ligand.
Conclusion:
Functional atherosclerosis is present in inflammatory bowel disease before early structural changes occur in vasculature. Higher sCD40L may indicate worse vascular outcome for IBD.
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