EXPRESS: Inflammatory bowel disease and cardiovascular risk: A meta-analysis

Inflammatory bowel disease (IBD) is a chronic immune-mediated intestinal disorder characterized by recurrent inflammation. Growing research over the last ten years has connected inflammatory bowel disease (IBD) to heightened heart-related danger, with major adverse cardiovascular events (MACE, including myocardial infarction, ischemic heart disease, ischemic stroke) arising earlier in life without reliance on conventional risk elements like high blood pressure or abnormal lipid levels.

A systematic literature search was performed in Medline, Embase, and the Cochrane Library to identify observational cohort and case-control studies published from January 2015 through June 2025. Only original observational cohort and case-control studies with adjusted outcome estimates were enrolled; systematic reviews, meta-analyses, Mendelian randomization studies, and preclinical studies were strictly excluded. Two independent reviewers extracted data and assessed methodological quality using the Newcastle-Ottawa Scale. Meta analysis was performed using random effects models; forest plots were generated to visualize pooled effect estimates. Heterogeneity, sensitivity analyses, and publication bias were formally evaluated.

A total of 3,126 records were retrieved, and finally 12 eligible original observational studies (10 cohort studies, 2 case-control studies) were included, involving 3,017,580 participants and 204,328 IBD cases. Pooled results showed that IBD was significantly associated with increased risks of MI (HR=1.41, 95%CI: 1.30-1.53, I²=45%), IHD (HR=1.37, 95%CI: 1.28-1.47, I²=53%), and ischemic CVA (HR=1.28, 95%CI: 1.19-1.38, I²=40%). Subgroup analysis indicated Crohn's disease (CD) had higher MI and IHD risks than ulcerative colitis (UC); active IBD and patients under 40 years also presented significantly elevated MACE risk. Additional subgroup analysis confirmed that high cumulative glucocorticoid exposure was independently associated with increased MACE risk (HR/RR=1.52, 95%CI: 1.31-1.76, P<0.001).

This meta-analysis confirms that IBD is independently associated with increased risk of MACE (MI, IHD, and ischemic CVA), with differential risks by subtype, disease activity, and age.