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Published on: October 14, 2025
Premature subclinical atherosclerosis in pediatric inflammatory bowel disease
Marina Aloi1, Luciana Tromba, Giovanni Di Nardo
1Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
Insights
Children with inflammatory bowel disease (IBD) show early signs of endothelial dysfunction, indicated by increased intima media thickness and reduced flow-mediated dilation. This finding highlights the need for cardiovascular disease prevention strategies in pediatric IBD management.
Area of Science:
- Pediatric Gastroenterology
- Cardiovascular Health
- Vascular Biology
Background:
- Inflammatory bowel disease (IBD) is increasingly diagnosed in children and adolescents.
- Endothelial dysfunction is an early marker of atherosclerosis, a condition that can lead to cardiovascular disease.
- The long-term cardiovascular implications of pediatric IBD are not fully understood.
Purpose of the Study:
- To investigate early endothelial dysfunction in pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC) using intima media thickness (IMT) and flow-mediated dilation (FMD).
- To identify traditional and nontraditional risk factors associated with premature atherosclerosis in pediatric IBD.
- To assess the role of IBD diagnosis as an independent risk factor for atherosclerosis.
Main Methods:
- A study involving 27 CD patients, 25 UC patients, and 31 healthy controls (mean age 15.2 years).
- Measurements included carotid artery intima media thickness (IMT) via ultrasound and brachial artery flow-mediated dilation (FMD).
- Demographic data, traditional cardiovascular risk factors, and disease activity indices were collected and analyzed.
Main Results:
- Patients with IBD exhibited significantly higher IMT and lower FMD compared to controls.
- Crohn's disease patients showed greater passive smoking exposure, lower body mass index, and reduced high-density lipoprotein cholesterol.
- Multivariate analysis confirmed that a diagnosis of IBD is an independent risk factor for atherosclerosis.
Conclusions:
- Pediatric IBD is associated with premature endothelial dysfunction.
- This dysfunction represents a significant challenge in managing pediatric IBD.
- Early detection and prevention strategies for cardiovascular disease are crucial for children with IBD.
Objectives:
To investigate the risk for developing an early endothelial dysfunction based on increased intima media thickness (IMT) and reduced flow-mediated dilation (FMD) in children with inflammatory bowel disease (IBD), and to evaluate the role of traditional and nontraditional risk factors in determining premature atherosclerosis.
Study Design:
We studied 27 patients with Crohn's disease (CD) and 25 patients with ulcerative colitis (UC) (mean age, 15.2 years; mean duration of disease, 48.05 months); 31 subjects served as controls. Demographic data (age, sex, family history of diabetes, cardiovascular disease, hypertension, hypercholesterolemia), traditional risk factors for atherosclerosis (blood pressure, body mass index, active and passive smoking, dyslipidemia), and UC and CD activity indexes (Pediatric Ulcerative Colitis Activity Index and Pediatric Crohn's Disease Activity Index, respectively) were collected. The IMT of the carotid arteries was measured by high-resolution B-mode ultrasound, and endothelial function was evaluated by FMD in the brachial artery in response to reactive hyperemia.
Results:
Compared with controls, patients with CD had significantly greater exposure to passive smoking and had lower body mass index and high-density lipoprotein cholesterol values. IMT was significantly higher in patients than controls (P < .0001), and the percentage of FMD was significantly lower in both patients with CD (P < .0001) and patients with UC (P < .01) versus controls. In multivariate analysis, diagnosis of IBD was an independent risk factor for atherosclerosis.
Conclusion:
Premature endothelial dysfunction occurs in pediatric IBD. This represents a new challenge in the management of pediatric IBD, leading to prevention strategies of cardiovascular disease.
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