Aortic Stiffening Is an Extraintestinal Manifestation of Inflammatory Bowel Disease: Review of the Literature and Expert Panel Statement

Abstract

Current guidelines state that systemic inflammation, together with endothelial dysfunction, calcification, and hypercoagulability, predispose to premature atherosclerosis in patients with inflammatory bowel disease (IBD). We assessed whether IBD can affect aortic stiffness, a well-recognized vascular biomarker and an independent risk factor for cardiovascular (CV) disease (CVD) in several populations. Recent studies reported that aortic stiffness is increased in adults with IBD compared with matched controls. This association is dependent on inflammatory burden and disease duration, and is reduced by antitumor necrosis factor therapy. Considered together, current findings suggest that increased aortic stiffness is an extraintestinal manifestation of IBD. This is clinically relevant since measuring aortic stiffness in patients with IBD could improve risk assessment, especially in those without established CVD. Moreover, effective control of inflammation could lower CV risk in patients with IBD by reducing aortic stiffness. Further longitudinal studies are needed to better clarify (i) the relationship between disease duration and irreversible changes of the arterial wall, (ii) the clinical characteristics of patients with IBD that have an increased arterial stiffness at least in part reversible, and (iii) whether arterial stiffness is useful to evaluate the efficacy of immunosuppressive therapy.

Aortic Elasticity Evaluated by Pulsed Tissue Doppler Imaging of the Ascending Aorta in Different Diseases: A Systematic Review

“…46 Studies reviewed in this article show that these pathologic events happen in a wide variety of CV and non-CV diseases through different mechanisms. 47…”

“…46 Studies reviewed in this article show that these pathologic events happen in a wide variety of CV and non-CV diseases through different mechanisms. 47 In patients with diabetes mellitus, it is suggested that the accumulation of advanced glycation end products in the aortic wall is responsible for the changes in compliance. 48 The products of nonenzymatic glycation of proteins and lipids were increased in patients with diabetes mellitus.…”

Atherosclerosis and Inflammatory Bowel Disease—Shared Pathogenesis and Implications for Treatment

“…Thus, in IBD patients, increased aortic stiffness may mediate the CV manifestations of blood pressure, IHD, and cerebrovascular events. 95…”

Reduction of Calciprotein Particles in Adults Receiving Infliximab for Chronic Inflammatory Disease

“…Their use in CID has been associated with improved bone mineral density and cardiovascular outcomes. (32)(33)(34)(35) Bone loss in CID is driven by both suppressed bone formation and enhanced bone resorption, and TNF-alpha inhibitor therapy has been shown to normalise markers of bone turnover. (36,37) Given the hypothetical links between CPP and bone turnover, we hypothesised that treatment of active CID with infliximab would lower circulating CPP levels and be temporally related to changes in markers of bone turnover.…”