Cardiovascular involvement in inflammatory bowel disease: Dangerous liaisons

Table 1 Cardiovascular risk in inflammatory bowel disease-the liaisons

Study	Results
MEDLINE, Cochrane Library, EMBASE meta-analysis; 33 studies enrolling 207814 IBD patients and 5774898 controls[5]	Increased risk of venous thromboembolism
	Increased risk of both ischemic heart disease and mesenteric ischemia
	No increased risk of arterial thromboembolism
	No increased cardiovascular mortality
Cohort study, 1708 patients (648 Crohn’s disease, 1060 ulcerative colitis), 35 yr follow-up[6]	A cumulative risk of venous thromboembolism after 15 yr after the diagnosis of 1.5% similar for both CD and UC
Systematic review and meta-analysis	Modest increase in the risk of CVA, especially among women and in young patients (< 40-50 yr old)
9 studies 2424 CVA events in 5 studies and 6478 IHD events 6 studies[8]	19% increase in the risk of IHD, primarily in women also
	No increased risk of peripheral arterial thromboembolic events
Cohort study, 20795 new onset IBD patients matched with 199978 controls[9]	Overall increased risk of MI, stroke, and cardiovascular death Increased risk during flares
Nation wide cohort study, 5436647 subjects without IBD or HF; follow up 11.8 yr 23681 IBD patients developed IBD follow up 6.4 yr	37% increased risk of hospitalization for HF in IBD Increased risk during flares
86790 Danish patients with first-time MI[11]	Increased risk of recurrent MI and for all-cause mortality especially during flares
Historical cohort study 2004-2010[12] Interventional catheterization database	IBD patients had CAD at a younger age as compared with non-IBD patients
131 IBD patients and 524 matched controls	IBD patients less likely to be active smokers and had a lower body mass index. No difference in post-PCI outcome in patients with IBD vs non-IBD controls with CAD

CD: Crohn’s disease; UC: Ulcerative colitis; IBD: Inflammatory bowel disease; CVA: Cerebrovascular accidents; IHD: Ischemic heart disease; HF: Heart failure; MI: Myocardial infarction; CAD: Coronary artery disease; PCI: Percutaneous intervention.

Table 2 Cardiovascular risk and inflammatory bowel disease treatment

Study	Results
Longitudinal study[13] 14 IBD subjects treated only with salicylates, 11 subjects treated with steroids and azathioprine, 7 subjects treated with anti TNF-α, and 30 matched controls pulse wave velocity was measured at baseline and 3.4 ± 0.5 yr later	Carotid-femoral pulse wave velocity increased significantly at follow-up in IBD subjects treated with salicylates, No increase of PWV in patients treated with steroids and azathioprine or anti TNF-α
Nationwide, population-based, cohort study, patients with IBD followed for up to 11 years after exposure to TNF-α antagonists	Protective effect of TNF-α antagonist on IHD
Cohort of 50756 IBD patients of whom 3109 had been exposed to TNF-α antagonists during 1999-2010[14]	TNF-α antagonists use might be a risk factor for CVA (increased trend, none of the values reached statistical significance)
Large retrospective study[15]	18% reduction in initiation of oral steroids
1986 statin exposed and 9871 unexposed subjects with IBD	Statistical significance for atorvastatin only
	Greater reduction in steroid use for UC patients and no reduction in Crohn’s disease
	Reduce hazard of anti TNF-α use, surgery and hospitalization (no statistical significance)

UC: Ulcerative colitis; IBD: Inflammatory bowel disease; CVA: Cerebrovascular accidents; IHD: Ischemic heart disease.