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Cardiovascular risk assessment in inflammatory bowel disease with metabolic dysfunction-associated steatotic liver
Sandra García-Mateo1, Samuel J Martínez-Domínguez1, Carla J Gargallo-Puyuelo1
1Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) significantly increases cardiovascular risk in inflammatory bowel disease (IBD) patients, particularly women. Dense LDL particles are also linked to early atherosclerosis in this population.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Hepatology
Background:
- Inflammatory bowel disease (IBD) is associated with an increased risk of early atherosclerosis.
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is underdiagnosed and linked to cardiovascular risk, with a known association with IBD.
- Assessing cardiovascular risk in IBD patients requires understanding comorbidities like MASLD.
Purpose of the Study:
- To investigate the impact of MASLD on cardiovascular risk in IBD patients.
- To analyze advanced lipoprotein profiles and carotid artery intima-media thickness (CIMT) in IBD patients with and without MASLD.
- To identify specific lipoprotein subclasses associated with atherosclerosis in IBD.
Main Methods:
- A cross-sectional cohort study of 941 adult IBD outpatients.
- Inclusion of 50 IBD patients with MASLD and 50 IBD patients without MASLD, matched for sex and age.
- Evaluation of CIMT alterations (above 75th percentile) and advanced lipoprotein profiles via nuclear magnetic resonance spectroscopy.
Main Results:
- 58% of patients exhibited abnormal CIMT.
- MASLD (OR=5.05) and female sex (OR=3.32) were significantly associated with CIMT alterations.
- Dense LDL particles, not total LDL cholesterol, were linked to CIMT alterations, especially in younger patients with high triglyceride density.
Conclusions:
- MASLD and female sex are significant risk factors for early atherosclerosis in IBD patients.
- Dense LDL particles are associated with subclinical atherosclerosis in IBD.
- Advanced lipoprotein profiles and CIMT can serve as non-invasive tools for cardiovascular risk management in IBD.
Background And Aims:
Inflammatory bowel disease (IBD) has been reported to increase the risk of early atherosclerosis even in young patients. Moreover, metabolic dysfunction-associated steatotic liver disease (MASLD), which has been linked to IBD, is a well-recognized but underdiagnosis entity related to cardiovascular risk. We analyze the impact of MASLD in IBD patients' cardiovascular risk through both advanced lipoprotein profile sorted by nuclear magnetic resonance spectroscopy, and carotid artery intima-media thickness (CIMT).
Methods:
Cross-sectional cohort study which involves 941 IBD adult outpatients. Of them, 50 patients with IBD who met criteria for MASLD and 50 with IBD without MASLD, matched by sex and age were included. Alterations in CIMT were evaluated considering abnormal measures above the 75th percentile adjusted for sex and age. Specific advanced lipoprotein profile was also carried out.
Results:
Most of the patients had an abnormal CIMT (58%). MASLD (OR=5.05, CI 95%=1.71-14.92) and female sex (OR=3.32, CI 95%=1.03-10) were significantly associated with CIMT alterations. Dense LDL particles (with high cholesterol composition in general cohort (OR=3.62, 95% CI=1.07-12.19) and high triglycerides density in young subgroup (OR=6.25, 95% CI=1.04-50) but not total LDL cholesterol were associated with CIMT alterations.
Conclusions:
MASLD and female sex are associated with early atherosclerosis in IBD patients. Dense LDL particle in combination with vascular imaging findings should be evaluated as non-invasive tools in the management of cardiovascular risk in IBD patients.
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