Highlights
- •Inflammatory bowel disease is associated with an increased risk of coronary artery disease, atrial fibrillation and stroke
- •Inflammatory bowel disease is associated with an increased risk of heart failure hospitalization
- •Ulcerative colitis but not Crohn's disease is associated with an increased risk of heart failure
- •Potential mechanisms between inflammatory bowel disease and cardiovascular diseases included atherosclerosis/endothelial dysfunction, dyslipidemia, thrombocytosis, dysbiosis of gut microbiota, and inflammatory bowel disease medications.
Abstract
Background and aim
: Emerging data showed patients with chronic inflammatory disorders, including inflammatory
bowel disease, are more likely to develop atherosclerotic cardiovascular diseases,
heart failure, and atrial fibrillation. This article aims to review the evidence of
those associations.
Methods
PubMed was searched from inception to January 2022 using the keywords, including inflammatory
bowel diseases, Crohn's disease, ulcerative colitis, atherosclerotic cardiovascular
disease, coronary artery disease, cardiovascular disease, atrial fibrillation, heart
failure, and premature coronary artery disease. Relevant literature, including retrospective/prospective
cohort studies, clinical trials, meta-analyses, and guidelines were reviewed and summarized.
Results
Both ulcerative colitis and Crohn's disease are associated with an increased risk
of atherosclerotic cardiovascular diseases, cerebrovascular accidents, premature coronary
artery disease, and atrial fibrillation. Ulcerative colitis is associated with an
increased risk of heart failure. The increased atrial fibrillation occurred during
inflammatory bowel disease flares and persistent activity, but not during periods
of remission. Hypotheses for the mechanism underlying the association of inflammatory
bowel disease and atherosclerotic cardiovascular diseases include shared risk factors
(i.e., obesity, diabetes, smoking, diet) and pathophysiology (gut microbiome dysfunction),
or adverse effects from inflammatory bowel disease itself or its treatment (i.e.,
chronic inflammation, dyslipidemia, thrombocytosis, steroids).
Conclusion
Inflammatory bowel disease is associated with an increased risk of atherosclerotic
cardiovascular diseases, heart failure, and atrial fibrillation. A multidisciplinary
team with gastroenterologists and cardiologists is needed to optimize the care for
patients with inflammatory bowel disease and associated cardiac diseases.
Keywords
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