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Published on: September 22, 2019
Epidemiology, risk factors and management of cardiovascular diseases in IBD
Siddharth Singh1, Iftikhar J Kullo2, Darrell S Pardi1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Inflammatory bowel disease (IBD) patients face higher risks of cardiovascular events like heart attack and stroke. This increased risk, linked to chronic inflammation, is notable in young adults and women.
Area of Science:
- Gastroenterology and Cardiology
- Systemic Inflammation and Cardiovascular Risk
Background:
- Inflammatory bowel disease (IBD) is a known risk factor for venous thromboembolism.
- Emerging evidence suggests IBD patients have an elevated risk of coronary heart disease and stroke, comparable to other chronic inflammatory conditions like rheumatoid arthritis.
Purpose of the Study:
- To evaluate the association between IBD and cardiovascular disease (CVD).
- To explore the role of chronic inflammation in IBD-associated CVD.
- To investigate potential risk modifications by disease activity and therapies.
Main Methods:
- Review of studies investigating cardiovascular risk in IBD patients.
- Analysis of conventional cardiovascular risk factors in IBD cohorts.
- Examination of biochemical and genetic markers related to atherosclerosis in IBD.
Main Results:
- Increased risk of coronary heart disease and stroke in IBD patients, particularly young adults and women.
- Conventional cardiovascular risk factors are not disproportionately present in IBD patients.
- Evidence of premature atherosclerosis and shared risk markers between IBD and atherosclerotic CVD.
Conclusions:
- Chronic inflammation in IBD may drive inflammation-mediated atherosclerosis, leading to increased CVD risk.
- Further research is needed on the impact of IBD disease activity and treatments (immunosuppressants, biologics) on cardiovascular risk.
- Preclinical data suggest potential benefits of cardiovascular medications (statins, ACE inhibitors) on IBD activity, warranting clinical evaluation.
Abstract:
IBD is an established risk factor for venous thromboembolism. In the past few years, studies have suggested that patients with IBD might also be at an increased risk of coronary heart disease and stroke. The increased risk is thought to be similar to the level of risk seen in patients with other chronic systemic inflammatory diseases such as rheumatoid arthritis. The risk of developing these conditions is particularly increased in young adults with IBD, and more so in women than in men. Conventional cardiovascular risk factors are not over-represented in patients with IBD, so the increased risk could be attributable to inflammation-mediated atherosclerosis. Patients with IBD often have premature atherosclerosis and have biochemical and genetic markers similar to those seen in patients with atherosclerotic cardiovascular disease. The role of chronic inflammation in IBD-associated cardiovascular disease merits further evaluation. Particular attention should be given to the increased risk observed during periods of increased disease activity and potential modification of the risk by immunosuppressive and biologic therapies for IBD that can modify the disease activity. In addition, preclinical studies suggest that cardiovascular medications such as statins and angiotensin-converting enzyme inhibitors might also favourably modify IBD disease activity, which warrants further evaluation.
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