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Cardiovascular involvement in inflammatory bowel disease: Dangerous liaisons
Ana Maria Filimon1, Lucian Negreanu1, Michelle Doca1
1Ana Maria Filimon, Andreea Ciobanu, Dragos Vinereanu, Internal Medicine and Cardiology Department, University Hospital Carol Davila University of Medicine Bucharest, 011465 Bucharest, Romania.
Insights
Patients with inflammatory bowel disease (IBD) face higher risks of heart attack, stroke, and death from cardiovascular disease, particularly during active disease flares. Managing IBD effectively may help lower this risk.
Area of Science:
- Cardiology
- Gastroenterology
- Immunology
Background:
- Emerging evidence links inflammatory bowel disease (IBD) with increased cardiovascular events.
- Recent meta-analyses and cohort studies highlight the association between gut inflammation and cardiovascular pathology.
Discussion:
- Patients with IBD exhibit a significantly elevated risk for myocardial infarction, stroke, and cardiovascular mortality, especially during active disease flares.
- Certain demographics, including women and younger patients, may experience a disproportionately higher cardiovascular risk.
- Current IBD treatments targeting disease remission show potential in mitigating cardiovascular risk.
Key Insights:
- Salicylates demonstrate a beneficial cardiovascular effect in IBD patients, unlike steroids or azathioprine.
- Tumor necrosis factor-α antagonists present complex cardiovascular profiles, potentially reducing ischemic heart disease risk while increasing cerebrovascular event rates.
Outlook:
- Further research is needed to explore supplemental treatment strategies for reducing atherothrombotic risk during IBD activity.
- Investigating novel therapeutic approaches to manage the dual burden of IBD and cardiovascular disease is crucial.
Abstract:
Increasing evidence of a link between inflammatory bowel disease (IBD) and adverse cardiovascular events has emerged during the last decade. In 2014, an important number of meta-analyses and cohort studies clarified the subtle dangerous liaisons between gut inflammation and cardiovascular pathology. The evidence suggests that patients with IBD have a significantly increased risk of myocardial infarction, stroke, and cardiovascular mortality, especially during periods of IBD activity. Some populations (e.g., women, young patients) may have an even greater risk. Current effective treatment of IBD is aimed at disease remission and seems to reduce cardiovascular risk in these patients. A beneficial effect was demonstrated for salicylates, but not for steroids or azathioprine. tumor necrosis factor-α antagonists, which are highly effective in the reduction of inflammation and in the restoration of the digestive mucosa, lead to conflicting cardiovascular effects, as they seem to reduce the risk for ischemic heart disease but increase the rate of cerebrovascular events. Future supplemental treatment strategies that may reduce the atherothrombotic risk during periods of IBD activity should be explored.
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