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Risk of cardiovascular disease in inflammatory bowel disease
Nynne Nyboe Andersen1, Tine Jess1
1Nynne Nyboe Andersen, Tine Jess, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark.
Insights
Inflammatory bowel disease (IBD) is linked to venous clots, but arterial clot risks like heart disease remain unclear. Chronic inflammation in IBD may increase atherosclerosis and cardiovascular disease risk.
Area of Science:
- Gastroenterology
- Cardiology
- Immunology
Background:
- Established link between inflammatory bowel disease (IBD) and venous thromboembolic events due to hypercoagulability.
- Uncertainty surrounds the risk of arterial thromboembolic disease in IBD patients, with conflicting study results.
- Chronic systemic inflammation in IBD is a plausible driver of atherosclerosis and subsequent thrombotic events.
Purpose of the Study:
- To review current evidence on the association between IBD and cardiovascular disease.
- To discuss the role of traditional and non-traditional risk factors in IBD patients.
- To clarify the debated risk of arterial thromboembolic events in IBD.
Main Methods:
- Literature review of existing scientific evidence.
- Analysis of studies investigating IBD and cardiovascular outcomes.
- Discussion of risk factors, including inflammation, atherosclerosis, and traditional cardiovascular risk factors.
Main Results:
- IBD is strongly associated with venous thromboembolism, with established prophylactic strategies.
- The risk of arterial thromboembolic events in IBD is debated, with inconsistent findings.
- Chronic inflammation in IBD may promote atherosclerosis, independent of traditional risk factors, suggesting a non-traditional pathway to cardiovascular disease.
Conclusions:
- Further research is needed to definitively establish the arterial thromboembolic risk in IBD.
- Chronic inflammation is a key non-traditional risk factor linking IBD and cardiovascular disease.
- Understanding these associations is crucial for managing cardiovascular risk in IBD patients.
Abstract:
Abundant scientific evidence supporting an association between inflammatory bowel disease (IBD) and venous thromboembolic events, caused by an IBD related hypercoagulability, is acknowledged and thromboprophylactic treatment strategies are now implemented in the management of IBD patients. In contrary, the risk of arterial thromboembolic disease, as ischemic heart disease, cerebrovascular events, and mesenteric ischemia in patients with IBD remains uncertain and the magnitude of a potentially increased risk is continuously debated, with ambiguous risk estimates among studies. The evident role of inflammation in the pathogenesis of atherosclerosis forms the basis of a biological plausible link; the chronic systemic inflammation in IBD patients increases the risk of atherosclerosis and thereby the risk of thrombotic events. Further, studies have shown that the burden of traditional risk factors for atherosclerosis, such as obesity, diabetes mellitus, and dyslipidemia is lower in IBD populations, thus further strengthen the role of non-traditional risk factors, as chronic inflammation in the linking of the two disease entities. Likewise, mortality from cardiovascular disease in IBD remains questioned. The aim of the current review is to give an up-date on the existing evidence of the possible association between IBD and cardiovascular disease and to discuss traditional and non-traditional risk factors.
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