Abstract
Chronic immune-mediated diseases, including inflammatory bowel disease (IBD), present an increased risk of developing early atherosclerosis and cardiovascular events (CVE) at early age. To describe the baseline and 1-year cardiovascular profile of patients with IBD according to the biologic treatment received, taking into account the inflammatory activity. It is a retrospective, observational study that included 374 patients. Cardiovascular risk factors (CVRF) and CVE were collected at the baseline visit and at one-year follow-up to describe the cardiovascular risk according to the biological treatment received, also assessing clinical and biological remission. A total of 374 patients were included: 146 (38.73%) were treated with Infliximab, 128 (33.95%) with adalimumab, 61 (16.18%) with ustekinumab and 42 (11.14%) with vedolizumab. The changes in blood glucose levels are [86.31 mg/dl (84.57–88.06) vs. 89.25 mg/dl (87.54–90.96), p = 0.001] for those treated with antiTNFα and [86.52 mg/dl (83.48–89.55) vs. 89.44 mg/dl (85.77–93.11), p = 0.11] in the other group. In the group treated with antiTNFα total cholesterol values at baseline visit are [169.40 mg/dl (164.97–173.83) vs. 177.40 mg/dl (172.75–182.05) at one year of treatment, p = <0.001], thoseof HDL [50.22 mg/dl (48.39–52.04) vs. 54.26 mg/dl (52.46–56.07), p = <0.001] and those of tri-glycerides [114.77 mg/dl (106.36–123.18) vs. 121.83 mg/dl (112.11–131.54), p = 0.054]. Regarding weight, an increase was observed, both in those patients treated with antiTNFα [71.39 kg (69.53–73.25) vs. 72.87 kg (71.05–74.70) p < 0.001], and in the group treated with ustekinumab and vedolizumab [67.59 kg (64.10–71.08) vs. 69.43 kg (65.65–73.04), p = 0.003]. Concerning CVE, no significant differences were observed neither according to the drug used (p = 0.36), nor according to personal history of CVE (p = 0.23) nor according to inflammatory activity (p = 0.46). Our results on a real cohort of patients with IBD treated with biologic drugs show a better control of certain cardiovascular parameters such as CRP or HDL, but a worsening of others such as total cholesterol or triglycerides, regardless of the treatment. Therefore, it is possibly the disease control and not the therapeutic target used, the one that affect the cardiovascular risk of these patients. Las enfermedades crónicas inmunomediadas, entre las cuales se encuentra la enfermedad inflamatoria intestinal (EII), presentan un riesgo mayor de desarrollar aterosclerosis precoz y eventos cardiovasculares (ECV) a edades tempranas. Describir el perfil cardiovascular basal y al año de tratamiento de los pacientes con EII según el tratamiento biológico recibido, teniendo en cuenta la actividad inflamatoria. Estudio retrospectivo y observacional que incluyó 374 pacientes. Se recogieron los factores de riesgo cardiovascular(FRCV) y los ECV en la visita basal y al año de seguimiento para describir el RCV según el tratamiento biológico recibido, valorando también la remisión clínica y biológica. Se incluyeron un total de 374 pacientes 146 (38,73%) fueron tratados con infliximab, 128 (33,95%) con adalimumab, 61 (16,18%) con ustekinumab y 42 (11,14%) con vedolizumab. Los cambios en el valor de glucemia son 86,31 mg/dl (84,57–88,06) vs. 89,25 mg/dl (87,54–90,96), p = 0,001, en el caso de los tratados con antifactor de necrosis (TNF)-α y de 86,52 mg/dl (83,48–89,55) vs. 89,44 mg/dl (85,77–93,11), p = 0.11, en el otro grupo. En el grupo tratado con antiTNFα los valores de colesterol total en la visita basal son 169,40 mg/dl (164,97–173,83) vs. 177,40 mg/dl (172,75–182,05) al año de tratamiento, p = <0,001, los de HDL 50,22 mg/dl (48,39–52,04) vs. 54,26 mg/dl (52,46–56,07), p = <0.001, y los de triglicéridos 114,77 mg/dl (106,36–123,18) vs. 121,83 mg/dl (112,11–131,54), p = 0,054. En cuanto al peso, se observó un aumento, tanto en aquellos pacientes tratados con anti-TNF-α (71,39 kg [69,53–73,25] vs. 72,87 kg [71,05–74,70], p < 0,001), como en el grupo tratado con ustekinumab y vedolizumab (67,59 kg [64,10–71,08] vs. 69,43 kg [65,65–73,04], p = 0,003]. En cuanto a los ECV, no se observaron diferencias clínica ni estadísticamente significativas ni en función del fármaco utilizado (p = 0,36), ni atendiendo a los antecedentes personales de ECV (p = 0,23) ni según la actividad inflamatoria (p = 0,46). Nuestros resultados sobre una cohorte real de pacientes con EII en tratamiento con fármacos biológicos objetivan un mejor control de ciertos parámetros cardiovasculares tales como la PCR o el HDL, pero con empeoramiento de otros como el colesterol total o los triglicéridos, independientemente del fármaco utilizado. Por lo tanto, es posiblemente el control de la enfermedad y no la diana terapéutica empleada lo que influya sobre el riesgo cardiovascular de estos pacientes.
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