Increased carotid intima–media thickness in patients with inflammatory bowel disease

Abstract

SUMMARYBackground: Patients with inflammatory bowel disease have an increased risk of thrombotic complications; moreover, mesenteric microvascular thrombosis has been hypothesized as a contributing factor in the pathogenesis of inflammatory bowel disease. Aim: To assess the extent of subclinical atherosclerosis in inflammatory bowel disease by measuring the intima-media thickness of the common carotid artery. Methods: Fifty-two patients were enrolled in the study. Patients aged >45 years, with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded from the study. Twenty healthy subjects were studied as controls. Carotid ultrasonography was performed in all patients and controls. intima-media thickness was measured proximal to the carotid bifurcation

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

“…Recently, researchers have focused on cardiovascular risk and on the possibility of early onset and rapid progression of the atherosclerotic process, with conflicting results [4][5][6][7][8][9].…”

“…From a clinical point of view, the assessment of early atherosclerosis has been made by investigating surrogate markers such as the carotid artery intima-media thickness (IMT), flow-mediated vasodilatation of the brachial artery (FMD) and arterial stiffness by pulse wave velocity (PWV) [21][22][23][24][25][26][27][28][29][30]. The study by Aloi et coll, reported signs of endothelial dysfunction and early atherosclerosis even in children with IBD [27].…”

Left middle cerebral artery infarct in a young man with Crohn's disease

“…2 For those affected the TE event occurred at a younger age than the non-IBD cohort (52 years vs. 64 years).…”

“…3 Its cause is unclear, but it may be related to increased levels of plasminogen activator inhibitor, factors V and VIII and fibrinogen or to decreased levels of factor V Leiden, factor XIII, antithrombin III, and proteins C and S. Thrombocytosis and increased spontaneous platelet aggregation also occurs. 4 Hyperhomocysteinaemia is an independent risk factor for arterial and venous thrombosis as well as atherosclerotic endothelial cell damage in young people 2 and increased levels of homocysteine have been found in both the circulation and intestinal mucosa of Crohn's patients. 2 Methionine synthase is a vital component of the metabolic pathways that prevent hyperhomocysteinaemia developing through the remethylation of cysteine, but this process is dependent upon folic acid and vitamin B12 4 which Crohn's patients are episodically deficient in during times of increased disease activity.…”

“…4 Hyperhomocysteinaemia is an independent risk factor for arterial and venous thrombosis as well as atherosclerotic endothelial cell damage in young people 2 and increased levels of homocysteine have been found in both the circulation and intestinal mucosa of Crohn's patients. 2 Methionine synthase is a vital component of the metabolic pathways that prevent hyperhomocysteinaemia developing through the remethylation of cysteine, but this process is dependent upon folic acid and vitamin B12 4 which Crohn's patients are episodically deficient in during times of increased disease activity.…”