Ischemic Heart Disease in Patients with Inflammatory Bowel Disease: Risk Factors, Mechanisms and Prevention

Abstract

According to new research, a possible association between inflammatory bowel disease (IBD) and an increased risk of ischemic heart disease (IHD) has been demonstrated, but this concern is still debatable. The purpose of this review is to investigate the link between IHD and IBD, as well as identify further research pathways that could help develop clinical recommendations for the management of IHD risk in IBD patients. There is growing evidence suggesting that disruption of the intestinal mucosal barrier in IBD is associated with the translocation of microbial lipopolysaccharides (LPS) and other endotoxins into the bloodstream, which might induce a pro-inflammatory cytokines response that can lead to endothelial dysfunction, atherosclerosis and acute cardiovascular events. Therefore, it is considered that the long-term inflammation process in IBD patients, similar to other chronic inflammatory diseases, may lead to IHD risk. The main cardiovascular risk factors, including high blood pressure, dyslipidemia, diabetes, smoking, and obesity, should be checked in all patients with IBD, and followed by strategies to reduce and manage early aggression. IBD activity is an important risk factor for acute cardiovascular events, and optimizing therapy for IBD patients should be followed as recommended in current guidelines, especially during active flares. Large long-term prospective studies, new biomarkers and scores are warranted to an optimal management of IHD risk in IBD patients.

Uncovering the Genetic Link between Acute Myocardial Infarction and Ulcerative Colitis Co-Morbidity through a Systems Biology Approach

“…Intestinal LPS binds LPS-binding protein and celiac particles, and enters the body's circulation through the lymphatics, thus enhancing the inflammatory process [46]. In addition, disruption of the intestinal mucosal barrier in UC leads to the transfer of LPS and other endotoxins into the bloodstream, thereby inducing a pro-inflammatory cytokine response that leads to endothelial dysfunction, atherosclerosis and acute cardiovascular events [14]. KEGG enrichment analysis highlighted the importance of lipid and atherosclerosis, RA, NF-kappa B, IL-17 and Tolllike receptor signaling pathways.…”

“…UC causes systemic inflammatory responses and promotes hypercoagulation in the body [13]. Furthermore, disruption of the intestinal mucosal barrier leads to the transfer of lipopolysaccharides (LPS) and other endotoxins into the bloodstream, thereby inducing the secretion of pro-inflammatory cytokines and leading to endothelial disturbances, atherosclerosis and acute cardiovascular events [14]. Gut microecological dysregulation increases plaque vulnerability by affecting lipid metabolism and the inflammatory response [15].…”

Krill Oil and Its Bioactive Components as a Potential Therapy for Inflammatory Bowel Disease: Insights from In Vivo and In Vitro Studies

“…Frequent complications associated with disease progression in CD are abscess and stricture formation, intestinal obstruction, and fistulas [4]. Moreover, patients with IBD have a higher risk of developing other complications, such as asthma or bronchitis, psoriasis, pericarditis, ischemic heart disease, and colon carcinoma [7][8][9][10]. Several key factors are related to the development of IBD, including genetic components (over 240 nonoverlapping genetic risk loci), environmental elements (e.g., smoking, diet, drugs, geography, social stress, and psychological elements), microbial dysbiosis, and altered immune responses [11,12].…”

Establishment of a hybrid model of atherosclerosis and acute colitis in ApoE-/- mice

“…In addition to the recognized traditional cardiovascular risk factors [1,2], such as smoking, hyperlipidemia, hypertension, diabetes, etc., an increasing number of epidemiological studies have shown that chronic inflammation plays an important role in the pathogenesis of atherosclerosis (AS) and CVD. Many epidemiological studies [3][4][5] have shown that CVD has been linked to rheumatoid arthritis and systemic lupus erythematosus, however, the association between inflammatory bowel disease (IBD) and CVD remains unclear. Emerging data indicate that the change of intestinal flora in IBD leads to the release of inflammatory cytokines into systemic circulation, thus accelerating the process of AS [6,7].A recent longitudinal study of 210,162 patients with IBD showed that the 3-month periods before and after inflammatory bowel disease-related hospitalization were associated with an increased risk of acute arterial events in both Crohn's disease and ulcerative colitis [8].…”