Cardiovascular manifestations of inflammatory bowel diseases and the underlying pathogenic mechanisms

Abstract

Inflammatory bowel disease (IBD), consisting of ulcerative colitis and Crohn's disease, mainly affects the gastrointestinal tract but is also known to have extraintestinal manifestations because of long-standing systemic inflammation. Several national cohort studies have found that IBD is an independent risk factor for the development of cardiovascular disorders. However, the molecular mechanisms by which IBD impairs the cardiovascular system are not fully understood. While the gut-heart axis is attracting more attention in recent years, our knowledge on the organ-to-organ communication between the gut and the heart remains limited. In patients with IBD, upregulated inflammatory factors, altered microRNAs and lipid profiles, as well as dysbiotic gut microbiota, may induce adverse cardiac remodeling. In addition, IBD patients have a 3-4 times higher risk of developing thrombosis than people without IBD and it is believed that the increased risk of thrombosis is largely due to increased procoagulant factors, platelet count/activity, and fibrinogen concentration, in addition to decreased anticoagulant factors. The predisposing factors for atherosclerosis are present in IBD and the possible mechanisms may involve oxidative stress system, overexpression of matrix metalloproteinases, and changes in vascular smooth muscle phenotype. This review focuses mainly on 1) prevalence of cardiovascular diseases associated with IBD, 2) the potential pathogenic mechanisms of cardiovascular diseases in IBD patients, and 3) adverse effects of IBD drugs on the cardiovascular system. Also, we introduce here a new paradigm for the gut-heart axis which includes exosomal microRNA and the gut microbiota as a cause for cardiac remodeling and fibrosis.

Navigating the Gut-Cardiac Axis: Understanding Cardiovascular Complications in Inflammatory Bowel Disease

“…The link between IBD and cardiovascular diseases is increasingly recognized, underscoring the importance of understanding this association. Numerous studies highlight that IBD patients may face a disrupted cardiovascular profile, leading to an elevated risk of cardiovascular complications such as coronary artery disease (CAD), stroke, thromboembolic events, pericarditis, myocarditis, arrhythmias, and venous and arterial thromboembolism [10][11][12]. According to a systematic review by Jaiswal et al, myocardial infarction (MI) occurred in 1.47% of IBD patients, while in UC and CD patients, it occurred at the rates of 30.96% and 34.14%, respectively.…”