Chronic pancreatitis and the heart disease: Still terra incognita?

Abstract

BACKGROUNDIt has been suggested that chronic pancreatitis (CP) may be an independent risk factor for development of cardiovascular disease (CVD). At the same time, it seems that congestive heart failure (CHF) and CP share the responsibility for the development of important clinical conditions such as sarcopenia, cachexia and malnutrition due to development of cardiac cachexia and pancreatic exocrine insufficiency (PEI), respectively.AIMTo explore the evidence regarding the association of CP and heart disease, more specifically CVD and CHF.METHODSA systematic search of MEDLINE, Web of Science and Google Scholar was performed by two independent investigators to identify eligible studies where the connection between CP and CVD was investigated. The search was limited to articles in the English language. The last search was run on the 1st of May 2019. The primary outcomes were: (1) Incidence of cardiovascular event [acute coronary syndrome (ACS), chronic coronary disease, peripheral arterial lesions] in patients with established CP; and (2) Incidence of PEI in patients with CHF.RESULTSOut of 1166 studies, only 8 were eligible for this review. Studies regarding PEI and CHF showed an important incidence of PEI as well as associated malabsorption of nutritional markers (vitamin D, selenium, phosphorus, zinc, folic acid, and prealbumin) in patients with CHF. However, after substitution of pancreatic enzymes, it seems that, at least, loss of appetite was attenuated. On the other side, studies investigating cardiovascular events in patients with CP showed that, in CP cohort, there was a 2.5-fold higher incidence of ACS. In another study, patients with alcohol–induced CP with concomitant type 3c diabetes had statistically significant higher incidence of carotid atherosclerotic plaques in comparison to patients with diabetes mellitus of other etiologies. Earlier studies demonstrated a marked correlation between the clinical symptoms in CP and chronic coronary insufficiency. Also, statistically significant higher incidence of arterial lesions was found in patients with CP compared to the control group with the same risk factors for atherosclerosis (hypertension, smoking, dyslipidemia). Moreover, one recent study showed that PEI is significantly associated with the risk of cardiovascular events in patients with CP.CONCLUSIONCurrent evidence implicates a possible association between PEI and malnutrition in patients with CHF. Chronic pancreatic tissue hypoxic injury driven by prolonged splanchnic hypoperfusion is likely to contribute to malnutrition and cachexia in patients with CHF. On the other hand, CP and PEI seem to be an independent risk factor associated with an increased risk of cardiovascular events.

Descripción clínica y epidemiológica de pacientes con pancreatitis crónica en un hospital de alta complejidad en Cali, 2011 a 2017

“…-Cálculos en el conducto pancreático 5 (27,8) -Dilatación del conducto pancreático 5 (27,8) RMN o CPRM 24 (29,6) -Cálculos en la vía biliar 4 (16,7)…”

Triglyceride to HDL-C Ratio Is Associated with Plasma D-Dimer Levels in Different Types of Pancreatitis: A Retrospective Single-Centered Study in China

“…So far, research on association between heart and pancreas disease has been paid little attention and its role in pathogenesis is not fully elucidated. The pathogenesis could be pancreatic enzymes and their inhibitors that profoundly affected blood coagulation and appear to in uence the course of pancreatic in ammation [59]. Researches have shown that in patients with chronic heart failure, the splanchnic circulation is decreased, especially in highly vascularized pancreas , which may cause pancreatitis [60].…”

Digestive Enzyme Activity and Protein Degradation in Plasma of Heart Failure Patients

“…14,30 Whereas correlations with pancreatitis have been proposed, no consensus exists. 27 We propose here a new hypothesis and provide initial evidence for a fundamental pathogenic mechanism that involves digestive enzymes.…”