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Subclinical atherosclerosis in inflammatory bowel disease: Prevalence, vascular distribution and implications for
Gonzalo Fernández Villar1, Fernando Garagoli1, Solange Martinez Elhelou2
1Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Vascular Doppler ultrasound identified significant subclinical atherosclerosis in inflammatory bowel disease patients, leading to improved cardiovascular risk assessment beyond standard scores.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Imaging
Background:
- Cardiovascular (CV) risk assessment in inflammatory bowel disease (IBD) is underexplored.
- IBD patients face increased CV risk, necessitating refined risk stratification strategies.
Purpose of the Study:
- To evaluate vascular Doppler ultrasound's role in enhancing CV risk stratification for IBD patients.
- To assess subclinical atherosclerosis prevalence and its impact on risk reclassification.
Main Methods:
- Cross-sectional study of 106 IBD patients (Crohn's disease and ulcerative colitis).
- Carotid and femoral Doppler ultrasound used to detect subclinical atherosclerosis.
- PREVENT 10-year risk score evaluated against ultrasound findings using ROC analysis.
Main Results:
- Subclinical atherosclerosis detected in 46% of patients.
- Vascular Doppler prompted risk reclassification in 30% of patients (41% upward, 11% downward).
- PREVENT score showed good discrimination (AUC=0.85), with an optimal cutoff of 2.8%.
Conclusions:
- Vascular Doppler imaging reveals high subclinical atherosclerosis prevalence in IBD.
- Doppler ultrasound significantly reclassifies CV risk beyond traditional scoring methods.
- This imaging modality offers valuable insights for managing CV risk in IBD.
Objective:
Cardiovascular (CV) risk assessment in patients with inflammatory bowel disease (IBD) remains insufficiently explored. This study aimed to assess the role of vascular Doppler ultrasound in refining CV risk stratification in patients with IBD.
Patients And Methods:
We conducted a cross-sectional study including patients with Crohn's disease (CD) and ulcerative colitis (UC) under active follow-up in a tertiary referral center. Consecutive patients referred for cardiology assessment according to predefined clinical criteria between May 2024 and December 2025 underwent carotid and femoral Doppler ultrasound to estimate the prevalence of atherosclerosis. Ultrasound operators were blinded to the CV risk score results and clinical risk stratification at time to image acquisition and interpretation. In the primary prevention cohort, the ability of the PREVENT 10-year risk score for detecting subclinical atherosclerosis was assessed using receiver operating characteristic (ROC) analysis. The optimal cutoff point was determined using the Youden index.
Results:
A total of 106 patients were included, of whom 100 without established atherosclerotic cardiovascular disease (ASCVD) constituted the main analytical population. The median age was 54.4 years, and 59% were men. Before Doppler assessment, 55% of patients were classified as low risk, 10% as borderline risk, 28% as intermediate risk, and 7% as high risk. Subclinical atherosclerosis was detected in 46%, prompting risk reclassification. Overall upward reclassification occurred in 41% and downward reclassification in 5%, yielding a net reclassification of 36%. The PREVENT 10-year risk score showed good discriminatory performance for the detection of subclinical atherosclerosis (AUC=0.85; 95% CI, 0.77-0.93), with an optimal cutoff value of 2.8%.
Conclusions:
Vascular Doppler imaging revealed a high prevalence of subclinical atherosclerosis and was associated with substantial CV risk reclassification beyond traditional scores.
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