Cardiovascular risk in inflammatory bowel disease: focus on lipids and visceral adipose tissue

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated diseases that are increasingly recognized as systemic diseases with significant cardiovascular consequences. Growing epidemiological evidence suggests that patients with IBD face an increased risk of atherosclerotic cardiovascular disease (ASCVD) that cannot be fully explained by traditional cardiovascular risk factors. This excess risk is most pronounced in younger patients and during periods of active intestinal inflammation. This review summarizes current knowledge on common pathogenic mechanisms linking IBD and ASCVD. Chronic systemic inflammation plays a central role, promoting endothelial dysfunction, hypercoagulability, immune cell activation, and accelerated atherogenesis. Other factors include intestinal barrier disruption with microbial translocation, dysbiosis of the gut microbiome, dysfunctional visceral adipose tissue, and adverse metabolic effects of some IBD therapies. Particular emphasis is placed on lipid abnormalities observed in IBD, including the "lipid paradox", a phenomenon in which reduced circulating lipid levels paradoxically coexist with increased cardiovascular risk due to inflammation-mediated changes in lipid metabolism leading to lipoprotein dysfunction, and emerging lipidomic biomarkers that suggest causal relationships between specific lipid species, inflammatory mediators, and cardiovascular risk. Attention is also given to current strategies for the assessment and prevention of cardiovascular risk in IBD, emphasizing the importance of controlling disease activity, minimizing corticosteroid exposure, and aggressive treatment of modifiable cardiovascular risk factors. Traditional risk calculators may underestimate risk in this population, highlighting the need for tools that integrate inflammatory burden and imaging of subclinical atherosclerosis. Optimization of anti-inflammatory therapy along with individualized cardiovascular prevention strategies may improve long-term outcomes in patients with IBD.