IBD Associated with Increased Cardiovascular Risk

Patients with inflammatory bowel disease (IBD) have a higher risk of stroke and heart attack, according to a new study recently presented at the American College of Gastroenterology’s Annual Scientific Meeting in San Diego.

“Like other chronic inflammatory diseases, patients with IBD have also been shown to have an increased thickness of the carotid intima-media, which is a measure of atherosclerotic disease burden,” said study author Siddharth Singh, MBBS, a researcher and gastroenterologist at the Mayo Clinic in Rochester, Minn.
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“Hence, chronic inflammation appears to be the reason behind the increased risk of cardiovascular diseases in these patients.”

To estimate the risk of stroke and heart disease in patients with IBD vs. the general population, Dr Singh and colleagues performed a systematic review and meta-analysis of 9 studies that included a total of more than 150,000 patients with IBD. They found a 10% to 25% increased risk of stroke and heart attacks in patients with IBD—and this higher risk was especially prominent in women.

“This is probably related to the inherent differences in traditional and non-traditional risk factors for stroke and ischemic heart disease in males and females,” Dr Singh said.

“Inflammation appears to play a greater role in IHD in women as compared to men; women have greater mean C-reactive protein measures compared with men; and the relative risk of future ischemic heart disease events increases proportionally with increasing levels of CRP in women, independent of the risk contributed by traditional cardiovascular risk factors.”

IBD was also associated with a 19% increase in the risk of IHD in patients with Crohn’s disease and ulcerative colitis, the most common forms of inflammatory bowel disease.

“Both primary physicians and gastroenterologists should be cognizant of this association and should focus on better management of conventional cardiovascular risk factors, such as smoking cessation, recognition and control of hypertension and diabetes, as well as maintaining long-term remission in patients with IBD to minimize the risk of inflammation-induced cardiovascular events,” Dr Singh said.

The researchers plan to further evaluate the role of active inflammation, and how modulating this inflammation using IBD medications modifies the association between IBD and cardiovascular events.

—Colleen Mullarkey