INFLAMMATORY BOWEL DISEASES AND THE RISK OF CARDIOVASCULAR EVENTS — A LITERATURE REVIEW

Abstract

Inflammatory bowel disease (IBD) — ulcerative colitis (UC) and Crohn's disease (CD) — comprises chronic, immune-mediated disorders of the gastrointestinal tract whose pathophysiological impact extends beyond the intestinal mucosa. A growing body of epidemiological evidence, including large-scale meta-analyses, indicates that patients with IBD carry an elevated risk of cardiovascular events, including coronary artery disease, stroke, heart failure (HF), venous thromboembolism (VTE), and atrial fibrillation (AF), despite a relatively lower prevalence of classical atherosclerotic risk factors in this population. This risk is particularly pronounced during periods of active, uncontrolled intestinal inflammation and in younger patients, in whom the contribution of the inflammatory process to overall cardiovascular risk is proportionally greatest. This review summarizes current evidence on the epidemiology of this association and the pathophysiological mechanisms linking chronic intestinal inflammation to vascular injury, including endothelial dysfunction, a prothrombotic state, gut microbiota dysbiosis and its metabolites — notably trimethylamine N-oxide (TMAO) — and inflammatory biomarkers. The differential impact of IBD pharmacotherapy on cardiovascular risk is also addressed, with particular emphasis on Janus kinase (JAK) inhibitors, associated with an elevated risk of thromboembolic complications, in contrast to biologic agents, which in several observational studies have demonstrated a potentially cardioprotective effect. The risk profile of TNF-α inhibitors in patients with coexisting heart failure is discussed separately. Finally, recommendations for cardiovascular risk stratification and prophylaxis in this population are presented, incorporating recent dedicated expert position statements from scientific societies, alongside directions for future investigation. Methods and Materials A systematic review of the scientific literature concerning the risk of cardiovascular events in patients with a diagnosed inflammatory bowel disease was conducted. Randomized controlled trials, meta-analyses, and [observational] studies were analyzed… Conclusions Particular attention should be paid to the assessment of cardiovascular event risk in patients with inflammatory bowel disease, especially in those who have had the disease for many years. Patients with inflammatory bowel disease [have an] increased risk of cardiovascular events, which is primarily attributable to chronic inflammation acting on the vascular wall through endothelial dysfunction, activation of coagulation, and disturbances of the gut microbiota, with the risk correlating more strongly with disease activity than with the diagnosis itself.