Abstract
Abstract Background Patients with inflammatory bowel disease (IBD) have an increased cardiovascular risk (CVR) and cardiovascular disease (CVD) is the leading cause of mortality in IBD patients. A more in-depth screening of patients has become important with the EMA warning for JAK-inhibitors. The current CV risk stratification algorithms are based on traditional risk factors not considering subclinical atherosclerosis. This study aimed to stratify the CVR of IBD patients according to the European Society of Cardiology (ESC 2021/23) and European Society of Atherosclerosis (EAS), together with the evaluation of the presence of previously subclinical atherosclerosis by carotid ultrasound. Methods Demographic and disease-related data were collected from consecutive IBD patients aged over 40 years, including systolic blood pressure, body mass index (BMI), lipid panel, and cardiovascular comorbidities. Asymptomatic atherosclerotic disease was assessed by carotid ultrasound in order to measure the carotid intima-media thickness (cIMT) and to detect the presence of plaques. CVR was stratified based on the latest guidelines on dyslipidemias (EAS/ESC 2019), cardiovascular prevention (ESC 2021), and the management of cardiovascular disease in patients with diabetes (ESC 2023). Moreover, additional IBD-related parameters potentially associated with an increased CVR were investigated, such as disease activity, current therapies, duration of disease, and extraintestinal manifestations. Results A total of 120 IBD patients were included (UC: 67 patients, CD: 53 patients) Baseline characteristics are presented in Table 1. Patients with UC had significantly higher mean values of total cholesterol (C-TOT) and low-density lipoprotein cholesterol (C-LDL) (p<0.001 and p=0.001 respectively). At baseline, 48% of patients were classified as having intermediate CVR, 34% as high risk, and 18% as very high risk (Table 2). Following carotid ultrasonography, subclinical atherosclerosis was diagnosed in 48.3% of patients. Based on these findings, CVR re-stratification was performed in 21% of patients resulting in 71% of patients with high and very high risk, compared to 50% at baseline. Additional risk factors for an increased CVR identified by multivariate regression analysis were having active disease (p=0.047) and concomitant spondiloathropathies (p=0.03). Conclusion Our study demonstrates that carotid ultrasound contributed to re-classify the CVR in patients who were previously considered to be in lower risk categories confirming that the use of traditional risk scores underestimates CVR in IBD patients. Having active intestinal disease and concomitant spondiloarthritis increases further the CV risk.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call