Risk of cardiovascular disease in inflammatory bowel disease

Abstract

Abundant scientific evidence supporting an association between inflammatory bowel disease (IBD) and venous thromboembolic events, caused by an IBD related hypercoagulability, is acknowledged and thromboprophylactic treatment strategies are now implemented in the management of IBD patients. In contrary, the risk of arterial thromboembolic disease, as ischemic heart disease, cerebrovascular events, and mesenteric ischemia in patients with IBD remains uncertain and the magnitude of a potentially increased risk is continuously debated, with ambiguous risk estimates among studies. The evident role of inflammation in the pathogenesis of atherosclerosis forms the basis of a biological plausible link; the chronic systemic inflammation in IBD patients increases the risk of atherosclerosis and thereby the risk of thrombotic events. Further, studies have shown that the burden of traditional risk factors for atherosclerosis, such as obesity, diabetes mellitus, and dyslipidemia is lower in IBD populations, thus further strengthen the role of non-traditional risk factors, as chronic inflammation in the linking of the two disease entities. Likewise, mortality from cardiovascular disease in IBD remains questioned. The aim of the current review is to give an up-date on the existing evidence of the possible association between IBD and cardiovascular disease and to discuss traditional and non-traditional risk factors.

Keywords: Inflammatory bowel disease; cardiovascular disease; Risk; Ulcerative colitis; Crohn’s disease

Core tip: The increased risk of venous thromboembolic events in inflammatory bowel disease (IBD) patients is well-established and prophylactic strategies are implemented in current guidelines. The risk of arterial thromboembolic complications in IBD remains uncertain. Together, the systemic inflammation in patients with IBD and the inflammation-driven development of atherosclerosis form the basis of a potential association between the two disease entities. The present review will provide a summary of the existing literature on the association between IBD and thromboembolic diseases and discuss potential risk and preventive factors.