Does cardiovascular risk matter in IBD patients?
Herbert Tilg1, Mathurin Fumery2, Charlotte R H Hedin3,4
1Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Inflammatory bowel disease (IBD) patients face increased cardiovascular and thromboembolic risks, especially with obesity and certain medications like Janus kinase (JAK) inhibitors and sphingosine 1-phosphate (S1P) receptor modulators. Regular cardiovascular risk assessment is crucial for IBD management.
Area of Science:
- Gastroenterology and Cardiology
- Pharmacology and Therapeutics
Background:
- Cardiovascular and thromboembolic risks are rising globally and impact inflammatory bowel disease (IBD) patients.
- Obesity, a worldwide health concern, affects IBD populations and may have a causal link to Crohn's disease.
- Active IBD itself elevates the risk of cardiovascular events like myocardial infarction and stroke.
Purpose of the Study:
- To highlight the significant cardiovascular risks associated with IBD.
- To detail the specific cardiovascular risks posed by Janus kinase (JAK) inhibitors and sphingosine 1-phosphate (S1P) receptor modulators used in IBD treatment.
- To emphasize the need for vigilant cardiovascular risk assessment and management in IBD patients.
Main Methods:
- Review of cardiovascular and thromboembolic risks in the general population and IBD patients.
- Analysis of cardiovascular side effects associated with JAK inhibitors (e.g., tofacitinib) and S1P receptor modulators.
- Discussion of risk factors including obesity, active IBD, and drug interactions.
Main Results:
- JAK inhibitors can lead to hypertension, dyslipidemia (elevated LDL, triglycerides), and atherosclerosis.
- S1P receptor modulators may cause transient bradycardia, AV block, QT interval prolongation, arrhythmias (e.g., Torsades de Pointes), and hypertension.
- Cardiovascular events in IBD patients often occur in those with pre-existing risk factors.
Conclusions:
- IBD healthcare providers must proactively assess cardiovascular risk in patients.
- Particular vigilance is required for patients on S1P modulators due to potential drug interactions and specific cardiac risks.
- Ongoing cardiovascular risk assessment should be integrated into routine IBD care.
Abstract:
Cardiovascular and thromboembolic risks are increasing in the population as a whole and therefore also in inflammatory bowel disease (IBD) patients. Obesity is a worldwide challenge also affecting the IBD population, and a causal association with Crohn's disease may exist. IBD itself, particularly when active, is also associated with a significant risk of thromboembolic and cardiovascular events such as myocardial infarction and stroke. Cardiovascular risk is also a significant consideration when using Janus kinase (JAK) inhibitors and sphingosine 1 phosphate (S1P) receptor modulators to treat IBD. JAK inhibitors - such as tofacitinib - are associated with several cardiovascular and venous thromboembolic risks, including hypertension and alterations in lipid profiles - specifically, increased LDL cholesterol and triglycerides - which may contribute to atherosclerosis and cardiovascular disease. S1P receptor modulators pose a slightly different set of cardiovascular risks. Initially, these drugs can cause transient bradycardia and atrioventricular (AV) block, leading to bradycardia. Moreover, they may induce QT interval prolongation, which increases the risk of life-threatening arrhythmias such as torsades de pointes. Some patients may also experience hypertension as a side effect. In this context, IBD healthcare providers need to be alert to the assessment of cardiovascular risk - particularly as cardiovascular events appear to be confined to specific patient groups with pre-existing risk factors. In addition, the potential for S1P modulator drug interactions requires a higher level of vigilance in patients with polypharmacy compared to biologics. Cardiovascular risk is not static, and updated assessment will need to become part of the routine in many IBD units.
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