From Gut Inflammation to Cardiovascular Conflagration: Mapping IBD's Cardiometabolic Risks

This review aims to characterize the known cardiovascular (CV) manifestations associated with inflammatory bowel disease (IBD) and the underlying mechanisms driving these associations.

Gut dysbiosis, a hallmark of patients with IBD, can result in both local and systemic inflammation, thereby potentially increasing the risk of cardiovascular disease (CVD) in the IBD population. Micronutrient deficiencies, anemia, and sarcopenia independently increase the risk of CVD and are frequent comorbidities of patients with IBD. IBD is a chronic inflammatory condition with significant and underrecognized cardiovascular complications. Patients with IBD frequently develop coronary artery disease (CAD) in the absence of traditional risk factors such as obesity and smoking and experience an earlier onset of CVD compared to the general population. Moreover, IBD has been associated with increased risks of arrhythmia, myocarditis, pericarditis, heart failure, and venous thromboembolism. Nontraditional risk factors related to IBD, including disease activity, prolonged disease duration, and cardiovascular risks associated with certain IBD medications, significantly contribute to the increased risk of CVD. While additional prospective research is required to fully elucidate the mechanisms driving CVD in IBD patients, current evidence suggests that minimizing disease activity, optimizing nutritional status, addressing gut dysbiosis, and mitigating the traditional risk factors could significantly reduce the burden of CVD in the IBD population. As our understanding of the link between IBD and cardiovascular disease grows, healthcare providers must closely monitor cardiovascular health and risk factors in patients with IBD, particularly during flares, active disease, and hospitalizations.