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Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut-Heart Connection
Ayman Jaaouani1, Abdulrahman Ismaiel2, Stefan-Lucian Popa2
1Faculty of Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Insights
Inflammatory bowel disease (IBD) may increase the risk of acute coronary syndromes (ACS), particularly during active disease and in younger patients. Remission appears to reduce this cardiovascular risk.
Area of Science:
- Cardiology
- Gastroenterology
- Systemic Inflammation
Background:
- Inflammatory bowel disease (IBD) is associated with systemic inflammation, similar to acute coronary syndromes (ACS).
- Existing research suggests a potential link between IBD and increased ACS risk, but findings remain inconclusive.
Purpose of the Study:
- To systematically review and clarify the association between IBD and the risk of developing ACS.
Main Methods:
- A systematic literature search was conducted across EMBASE, Cochrane Library, and PubMed for observational studies published before November 2020.
- Studies with histopathology or code-confirmed IBD diagnoses were included.
- Study quality was assessed using the Newcastle-Ottawa Scale (NOS).
Main Results:
- Twenty observational studies, encompassing approximately 132 million individuals, were included.
- Fifteen studies indicated a significant association between IBD and increased ACS risk.
- Five studies found no elevated ACS risk in patients with IBD.
Conclusions:
- ACS risk in IBD patients correlates with disease activity, hospitalizations, flares, and complications, decreasing during remission.
- Younger IBD patients demonstrated a generally increased risk of ACS.
- Further investigation is warranted into the role of corticosteroids and oral contraceptives in elevating ACS risk among IBD patients.
Abstract:
(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.
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