Thromboembolic and cardiovascular risk profiles in patients with ulcerative colitis initiating advanced therapies

Ulcerative colitis (UC) is associated with an increased risk of venous thromboembolism (VTE) and cardiovascular (CV) events, particularly during flares. While concerns have emerged regarding the intrinsic CV and thromboembolic risk of Janus kinase inhibitors, real-world data on baseline risk profiles in UC remain scarce.

This study aimed to assess the thromboembolic and cardiovascular risk profiles of UC outpatients initiating advanced therapies and to evaluate the incidence of related clinical events.

We conducted a cross-sectional study with prospective longitudinal follow-up at a single tertiary center.

Consecutive UC outpatients who initiated an advanced therapy between June 2020 and December 2023 were enrolled. Baseline VTE and CV risk factors were assessed using medical records, a structured online questionnaire, and the International Physical Activity Questionnaire. CV risk was estimated using the Atherosclerotic Cardiovascular Disease and Systematic Coronary Risk Estimation 2 calculators. Patients were monitored for VTE and CV events until December 2024.

The study included 300 patients (median age 44 years; 45.3% female). Most had 0-1 VTE risk factor (61.0%) and elevated C-reactive protein was the most common (45.0%). CV risk stratification showed that most non-elderly patients had low or moderate risk, while elderly patients showed higher risk. During a median follow-up of 27 months (683 person-years), only four events (1.3%, incidence rate 0.59 per 100 P-Y) were recorded: two VTE (both in patients on ustekinumab, one with multiple risk factors and one with cirrhosis) and two CV events (angina and retinal ischemia in low-risk patients on vedolizumab and adalimumab).

In our cohort, both thromboembolic and CV risks were overall low. CV risk was higher in elderly patients. The incidence of VTE and CV events during follow-up was low. These findings suggest that concerns regarding the intrinsic VTE and CV risks associated with Janus kinase inhibitors may not fully apply to UC patients.