A clinical case of early multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis

Abstract

Inflammatory bowel disease (IBD) is a chronic, relapsing, systemic and immune-mediated conditiondis that frequently involve extraintestinal manifestations. Latest studies showed increased risk of cardiovascular complications, which is the main cause of death in developed countries, in chronic inflammatory disorders, especially during IBD relapses. IBD patients are at increased risk of conditions such as early atherosclerosis, ischaemic heart disease, myocardial infarction, stroke, venous thrombosis, heart failure, аtrial fibrillation. Hypotheses for the mechanism underlying the association of IBD and atherosclerotic cardiovascular diseases include adverse effects of both the IBD itself (chronic inflammation, еndothelium dysfunction, dyslipidemia, thrombocytosis, gut microbiome dysfunction) and its treatment. The predominant role in atherogenesis is currently assigned to disruption of the endothelium. Endothelium plays an important role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. Early multifocal atherosclerosis is a serious complication of ulcerative colitis and can occur in young people without traditional cardiovascular risk factors. Untimely diagnosis, lack of pathogenetic treatment, correction of basic anti-inflammatory therapy and comprehensive consideration of a problem of high cardiovascular risk can lead to acute myocardial infarction and stroke and disability of a patient of working age. The authors present a case report of multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis, who required a radical revision of the therapy.