Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut-Heart Connection.

Ayman Jaaouani,Dan L Dumitrascu,Stefan-Lucian Popa,Abdulrahman Ismaiel

doi:10.3390/jcm10204710

Abstract

(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle–Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.

Highlights

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and Ulcerative colitis (UC), outlines the incurable chronic inflammation of the gastrointestinal tract affecting approximately 2.2 million people in Europe [1] and 7.7 million Americans [2], whilst in Asia the incidence is 1.4 per 100,000 [3]
IBD was thought to be limited to Caucasians in western countries but not anymore, as IBD was found to be rather related to environmental factors than ethnicity or heredity since most people do not present a family history and twin studies have not proven any concordance [4]
The original articles were included in the systematic review and qualitive assessment if they satisfied the following criteria: (1) Observational-study, population/hospital/primary care-based; (2) Inflammatory bowel disease confirmed by histopathology or International Classification of Disease (ICD) codes; (3) acute coronary syndromes (ACS) diagnosis based on the criteria established in each study; (4) Studies on humans solely

Summary

Introduction

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and Ulcerative colitis (UC), outlines the incurable chronic inflammation of the gastrointestinal tract affecting approximately 2.2 million people in Europe [1] and 7.7 million Americans [2], whilst in Asia the incidence is 1.4 per 100,000 [3]. The number of patients with IBD is growing exponentially and is expected to significantly increase in the western world. IBD was thought to be limited to Caucasians in western countries but not anymore, as IBD was found to be rather related to environmental factors than ethnicity or heredity since most people do not present a family history and twin studies have not proven any concordance [4]. An increase in IBD incidence and prevalence in newly industrialized countries is being explained by the populations’ shift towards urbanism, lifestyle changes such as smoking and diet, and increased exposure to pollution and sedentarism [5]

Methods

Results

Discussion

Conclusion