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The oft-overlooked cardiovascular complications of inflammatory bowel disease
Sara Massironi1, Giacomo Mulinacci1, Camilla Gallo1
1Division of Gastroenterology, and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca School of Medicine, Monza, Italy.
Insights
Inflammatory bowel disease (IBD) increases cardiovascular disease (CVD) risk, particularly during flares. Managing CVD risk involves thromboprophylaxis and achieving IBD remission.
Area of Science:
- Gastroenterology
- Cardiology
- Immunology
Background:
- Inflammatory bowel disease (IBD) is linked to cardiovascular disease (CVD) comorbidities.
- Chronic inflammation in IBD contributes to atherogenesis, thrombosis, and myocarditis.
Purpose of the Study:
- To review the association between IBD and CVD.
- To discuss the impact of IBD medications on cardiovascular outcomes.
- To provide expert opinion on managing CVD risk in IBD patients.
Main Methods:
- Literature review of IBD and CVD associations.
- Analysis of cardiovascular risks associated with IBD treatments.
- Expert opinion synthesis on risk management strategies.
Main Results:
- IBD patients face increased risks of atherosclerosis, cardiovascular events, and thromboembolism.
- Certain IBD therapies (anti-TNF, thiopurines) may offer arterial protection, while JAK inhibitors may increase VTE and CVD event risk.
- CVD risk is elevated in IBD, especially during flares, necessitating thromboprophylaxis in hospitalized patients.
Conclusions:
- Effective management combines thromboprophylaxis with achieving durable IBD remission.
- While CVD risk is elevated, it doesn't dictate specific IBD treatment choices.
- Further research is needed to fully elucidate the pathogenetic relationship and drug impacts.
Introduction:
Inflammatory bowel disease (IBD) may be associated with several extraintestinal comorbidities, including cardiovascular disease (CVD). Chronic inflammation is recognized as an important factor in atherogenesis, thrombosis, and myocarditis.
Areas Covered:
IBD patients may be at increased risk for developing early atherosclerosis, cardiovascular events, peripheral artery disease, venous thromboembolism, myocarditis, and arrhythmias. Anti-tumor necrosis factor agents and thiopurines have been shown to have a protective effect against acute arterial events, but more research is needed. However, an increased risk of venous thromboembolism and major cardiovascular events has been described with the use of Janus kinase inhibitors.
Expert Opinion:
CVD risk is slightly increased in patients with IBD, especially during flares. Thromboprophylaxis is strongly recommended in hospitalized patients with active disease as the benefit of anticoagulation outweighs the risk of bleeding. The pathogenetic relationship between CVD and IBD and the impact of IBD drugs on CVD outcomes are not fully elucidated. CVD risk doesn't have the strength to drive a specific IBD treatment. However, proper CVD risk profiling should always be done and the best strategy to manage CVD risk in IBD patients is to combine appropriate thromboprophylaxis with early and durable remission of the underlying IBD.
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