Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2015; 21(33): 9688-9692
Published online Sep 7, 2015. doi: 10.3748/wjg.v21.i33.9688
Cardiovascular involvement in inflammatory bowel disease: Dangerous liaisons
Ana Maria Filimon, Lucian Negreanu, Michelle Doca, Andreea Ciobanu, Carmen Monica Preda, Dragos Vinereanu
Ana Maria Filimon, Andreea Ciobanu, Dragos Vinereanu, Internal Medicine and Cardiology Department, University Hospital Carol Davila University of Medicine Bucharest, 011465 Bucharest, Romania
Lucian Negreanu, Michelle Doca, Internal Medicine 2 Gastroenterology Department, University Hospital, Carol Davila University of Medicine Bucharest, 011465 Bucharest, Romania
Carmen Monica Preda, Gastroenterology Department, Fundeni Clinical Institute, Carol Davila Medicine University, 011465 Bucharest, Romania
Author contributions: All authors contributed equally to the article.
Supported by (in part) Sectorial Operational Program Human Resources Development; European social fund; and the Romanian government, No. POSDRU 141531.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lucian Negreanu, MD, PhD, Internal Medicine 2 Gastroenterology Department, University Hospital, Carol Davila University of Medicine Bucharest, 169, splaiul Independentei Street, Sector 5, 011465 Bucharest, Romania. negreanu_99@yahoo.com
Telephone: +40-72-2546405 Fax: +40-21-3180505
Received: March 9, 2015
Peer-review started: March 10, 2015
First decision: March 26, 2015
Revised: April 14, 2015
Accepted: July 18, 2015
Article in press: July 18, 2015
Published online: September 7, 2015
Processing time: 182 Days and 12.4 Hours
Abstract

Increasing evidence of a link between inflammatory bowel disease (IBD) and adverse cardiovascular events has emerged during the last decade. In 2014, an important number of meta-analyses and cohort studies clarified the subtle dangerous liaisons between gut inflammation and cardiovascular pathology. The evidence suggests that patients with IBD have a significantly increased risk of myocardial infarction, stroke, and cardiovascular mortality, especially during periods of IBD activity. Some populations (e.g., women, young patients) may have an even greater risk. Current effective treatment of IBD is aimed at disease remission and seems to reduce cardiovascular risk in these patients. A beneficial effect was demonstrated for salicylates, but not for steroids or azathioprine. tumor necrosis factor-α antagonists, which are highly effective in the reduction of inflammation and in the restoration of the digestive mucosa, lead to conflicting cardiovascular effects, as they seem to reduce the risk for ischemic heart disease but increase the rate of cerebrovascular events. Future supplemental treatment strategies that may reduce the atherothrombotic risk during periods of IBD activity should be explored.

Keywords: Inflammatory bowel disease; Thrombotic events; Active disease; Cardiovascular risk; Anti-tumor necrosis factor-α

Core tip: New evidence from an important number of meta-analyses and cohort studies suggests that patients with inflammatory bowel disease (IBD) have a significantly increased risk of myocardial infarction, stroke, and cardiovascular mortality especially during periods of active disease and particularly in some high-risk populations, such as women and younger patients. The current treatment paradigm, which is aimed at deep, sustained remission, might reduce cardiovascular risk in patients with IBD. Treatment strategies such as the supplemental administration of statins to reduce the atherothrombotic risk should be further explored.