Increased Cardiovascular Risk in Patients With Inflammatory Bowel Disease

Abstract

In an article recently published in Clinical Gastroenterology and Hepatology, Aniwan et al1Aniwan S. et al.Clin Gastroenterol Hepatol. 2018; 16: 1607-1615Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar reported that the risk of acute myocardial infarction and heart failure was increased in patients with inflammatory bowel disease. This finding is clinically relevant and is in accordance with 4 recent meta-analyses showing an increased aortic pulse wave velocity,2Zanoli L. et al.J Hypertens. 2016; 34: 822-829Crossref PubMed Scopus (39) Google Scholar, 3Wu G.C. et al.Angiology. 2017; 68: 447-461Crossref PubMed Scopus (37) Google Scholar, 4Zanoli L. et al.J Am Heart Assoc. 2017; 6Crossref PubMed Scopus (48) Google Scholar a well-established and independent cardiovascular risk marker and an intermediate end point for cardiovascular events, and an increased return of reflected waves in patients with inflammatory bowel disease.5Zanoli L. et al.Eur J Intern Med. 2017; 39: e31-e32Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar In this regard, the recent finding that a significant relationship between aortic stiffness and left ventricular systolic and diastolic dysfunction is present in patients with inflammatory bowel disease6Aslan A.N. et al.Cardiol J. 2016; 23: 202-210Crossref PubMed Scopus (16) Google Scholar can explain why these patients have an increased cardiovascular risk despite a low prevalence of classic cardiovascular risk factors1Aniwan S. et al.Clin Gastroenterol Hepatol. 2018; 16: 1607-1615Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar (the so-called “inflammatory bowel disease paradox“7Zanoli L. et al.Trends Cardiovasc Med. 2015; 25: 705-706Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar). Chronic inflammation leads to aortic stiffening; the increased aortic stiffness may lead to cardiac remodeling and cardiovascular events in patients with inflammatory bowel disease. Moreover, systemic corticosteroids, immunosuppressives, and biologics are used in patients with other diseases with chronic severe inflammation (ie, rheumatoid arthritis) who are at an increased risk of cardiovascular events; these subjects were included in the control group in the study of Aniwan et al.1Aniwan S. et al.Clin Gastroenterol Hepatol. 2018; 16: 1607-1615Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar It therefore is possible that the risk of acute myocardial infarction and heart failure could have been even higher than the reported estimates if only healthy control subjects had been used. Finally, Aniwan et al1Aniwan S. et al.Clin Gastroenterol Hepatol. 2018; 16: 1607-1615Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar reported an increased risk of acute myocardial infarction and heart failure among users of systemic corticosteroids; this risk was higher than that observed in patients treated with biologics. Several investigators have raised the question of whether the optimal control of inflammation can lead to the reduction of cardiovascular risk in subjects with inflammatory bowel disease. In this regard, recent evidence has suggested that salicylates could be associated with an increase in aortic stiffness,8Zanoli L. et al.J Hypertens. 2017; 35: 898-899Crossref PubMed Scopus (5) Google Scholar raising the question about the role of salicylates as maintenance therapy, whereas anti–tumor necrosis factor α therapy could be associated with a reduction in aortic stiffness.2Zanoli L. et al.J Hypertens. 2016; 34: 822-829Crossref PubMed Scopus (39) Google Scholar Therefore, it could be of interest to know whether patients treated with salicylates, not considered in the study by Aniwan et al,1Aniwan S. et al.Clin Gastroenterol Hepatol. 2018; 16: 1607-1615Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar have an increased risk of acute myocardial infarction and heart failure than those treated with biologics. Increased Risk of Acute Myocardial Infarction and Heart Failure in Patients With Inflammatory Bowel DiseasesClinical Gastroenterology and HepatologyVol. 16Issue 10PreviewThere are conflicting data as to whether inflammatory bowel diseases (IBDs) increase risk for cardiovascular disease. We sought to examine the risk of acute myocardial infarction (AMI) and heart failure in patients with IBD. Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 17Issue 4PreviewWe appreciate Dr Zanoli’s comments in their letter to the editor, “Increased Cardiovascular Risk in Patients With Inflammatory Bowel Disease.”1 Full-Text PDF