在IBD患者中,心血管风险是否重要?
Herbert Tilg1, Mathurin Fumery2, Charlotte R H Hedin3,4
1Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Innsbruck, Austria.
Journal of internal medicine
|October 29, 2023
概括
炎症性肠病 (IBD) 患者面临心血管和血栓栓塞的风险增加,特别是在肥胖和某些药物,如Janus激酶 (JAK) 抑制剂和斯芬戈-1-酸盐 (S1P) 受体调节剂. 定期进行心血管风险评估对于IBD管理至关重要.
科学领域:
- 胃肠病学和心脏病学
- 药理学和治疗学 药理学和治疗学
背景情况:
- 心血管和血栓栓塞的风险正在全球上升,并影响炎症性肠病 (IBD) 患者.
- 肥胖是一个全球性的健康问题,影响IBD人口,可能与克罗恩病有因果关系.
- 活性IBD本身会增加心血管事件的风险,如心肌梗塞和中风.
研究的目的:
- 突出与IBD相关的显著心血管风险.
- 详细说明在IBD治疗中使用的Janus激酶 (JAK) 抑制剂和sphingosine 1-phosphate (S1P) 受体调节剂所带来的特定心血管风险.
- 强调需要对IBD患者进行警的心血管风险评估和管理.
主要方法:
- 对一般人群和IBD患者的心血管和血栓栓塞风险的审查.
- 与JAK抑制剂 (如托法西提尼布) 和S1P受体调节剂相关的心血管副作用的分析.
- 讨论风险因素,包括肥胖,活性IBD和药物相互作用.
主要成果:
- 雅克抑制剂可以导致高血压,脂质失调 (增加的LDL,甘油三) 和动脉样硬化.
- S1P受体调节器可能会导致暂时的胸,AV阻塞,QT间隔延长,心律失常 (例如,Torsades de Pointes) 和高血压.
- 在IBD患者中,心血管事件通常发生在那些具有先前存在的风险因素的人身上.
结论:
- IBD医疗保健提供者必须主动评估患者的心血管风险.
- 由于潜在的药物相互作用和特定的心脏风险,S1P调节器的患者需要特别警.
- 持续的心血管风险评估应纳入IBD常规护理.
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