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Management of Atherosclerotic Cardiovascular Risk in Inflammatory Bowel Disease: Current Perspectives
Walter Masson1, Gonzalo Fernández-Villar2, Solange Martinez-Elhelou3
1Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. walter.masson@hospitalitaliano.org.ar.
Insights
Inflammatory bowel disease (IBD) patients face higher risks of atherosclerotic cardiovascular disease due to chronic inflammation and other factors. Early detection and multidisciplinary care are crucial for managing cardiovascular health in IBD.
Area of Science:
- Gastroenterology and Cardiology
- Immunology and Cardiovascular Medicine
Background:
- Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, involves chronic gastrointestinal inflammation.
- IBD patients exhibit an elevated risk of atherosclerotic cardiovascular disease (ASCVD).
- Contributing factors include traditional risk factors, chronic inflammation, dysbiosis, thrombosis, and corticosteroid use.
Purpose of the Study:
- To review epidemiological evidence linking IBD with cardiovascular risk factors and disease.
- To explore pathophysiological mechanisms and challenges in cardiovascular risk assessment for IBD patients.
- To discuss therapeutic implications and the importance of multidisciplinary care.
Main Methods:
- Review of epidemiological studies on IBD and cardiovascular disease.
- Analysis of potential pathophysiological mechanisms.
- Examination of cardiovascular risk assessment tools and therapeutic strategies.
Main Results:
- IBD is associated with increased cardiovascular risk through multiple mechanisms.
- Gaps exist in managing cardiovascular risk factors and using preventive medications in IBD patients.
- Cardiovascular effects of newer IBD therapies require further investigation.
Conclusions:
- Comprehensive cardiovascular risk assessment, including subclinical atherosclerosis detection, is vital for IBD patients.
- Multidisciplinary collaboration among gastroenterologists, cardiologists, and general practitioners is essential.
- Integrated management strategies are needed to address the heightened cardiovascular risk in IBD.
Abstract:
Inflammatory bowel disease (IBD) is a complex condition characterized by inflammation of the gastrointestinal system, encompassing Crohn's disease and ulcerative colitis. Patients diagnosed with IBD have an increased risk of atherosclerotic cardiovascular disease. This heightened risk can be attributed to a combination of mechanisms, including traditional risk factors, chronic inflammation, intestinal dysbiosis, increased risk of thrombosis, and the use of certain medications such as corticosteroids. There are significant gaps in current knowledge, particularly regarding the management of risk factors and the use of medications for cardiovascular disease prevention. Similarly, the cardiovascular effects of specific IBD therapies, particularly the newer ones, are not yet fully understood. This review focuses on the epidemiological evidence linking IBD with cardiovascular risk factors and cardiovascular disease. It describes the potential pathophysiological mechanisms underlying this association and examines the challenges involved in accurately assessing cardiovascular risk in these patients, including the utility of complementary tools such as subclinical atherosclerosis detection. Additionally, we consider the potential therapeutic implications for managing these patients. Finally, this review also underscores the importance of multidisciplinary collaboration. Effective teamwork among gastroenterologists, cardiologists, and general practitioners is essential for providing comprehensive care to patients with IBD.
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