Premature Subclinical Atherosclerosis in Pediatric Inflammatory Bowel Disease

Aloi, Marina; Tromba, L; Nardo, Giovanni Di; Dilillo, Anna; Giudice, Emanuela Del; Marocchi, Elisa; Viola, Franca; Civitelli, Fortunata; Berni, A; Cucchiara, Salvatore

doi:10.1016/j.jpeds.2012.03.043

Cited by 68 publications

(73 citation statements)

References 38 publications

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“…Our data confirm the results of most studies conducted in Mediterranean area [27][28][29][30], though other studies, carried out in Israel obtained opposite results [22][23]. We could speculate that ethnicity might have an influence on the risk of atherogenesis, being higher in population from Italy and Turkey, as compared with population from Israel, even if, we do not have any genetic markers to support our hypothesis.…”

Section: Discussionsupporting

confidence: 87%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…The study by Aloi et coll, reported signs of endothelial dysfunction and early atherosclerosis even in children with IBD [27]. Zanoli et al reported results from two studies [29,30] carried on IBD adult patients evaluated by measuring arterial stiffness, the first being a cross-sectional study, the second evaluating the effect of long-term therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Cappello

Licata

Calvaruso

et al. 2017

European Journal of Internal Medicine

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Background & Aims:Recent studies documented an increased cardiovascular risk in patients with inflammatory bowel disease (IBD). Our study aimed at investigating the prevalence of intima-media thickness (IMT) of the carotid arteries and the arterial stiffness indices as markers of early atherosclerosis in young IBD patients. Methods: We recruited 68 consecutive IBD patients, and 38 matched healthy controls less than 45 years old (median age 31.6 ± 8.1 years). Clinical and demographic features, cardiovascular risk factors, history of cardiovascular events, concomitant therapies were registered on a dedicate database. Carotid IMT was evaluated by using high resolution B-mode ultrasonography. Arterial stiffness was assessed by measurement of carotidfemoral Pulse Wave Velocity (PWV) and Augmentation Index (AIx). Results: Total cholesterol (P b 0.013) and LDL-cholesterol (P b 0.019) levels were significantly lower in IBD patients compared to controls. Carotid IMT was higher in IBD than in controls (P b 0.047), but there was no statistically significant difference among Crohn's Disease (CD) and Ulcerative Colitis (UC) patients. Moreover, PWV and AIx were significantly higher in patients as compared to controls (P b 0.006 and P b 0.004 respectively). No medication seemed to affect vascular measurements, though stiffness parameters were significantly higher in patients treated with 5-ASA (11.9 (9.7) vs 18.2 (10.2), P b 0.021), suggesting a lack of efficacy of 5-ASA in protecting IBD patients from early atherogenesis. Conclusions: Young IBD patients show an increase in subclinical markers of atherosclerosis. Future studies need to address whether these markers result in an increased risk of cardiovascular events in these patient.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Cappello

Licata

Calvaruso

et al. 2017

European Journal of Internal Medicine

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“…In one study, children with IBD had higher carotid intima-media thickness and lower flow-mediated dilation than healthy control individuals, which correlated with Crohn's disease activity but not ulcerative colitis activity. 39 Biochemical changes Several inflammation-associated biochemical changes are observed in both IBD and cardiovascular disease. Patients with IBD and active inflammation frequently have raised levels of CRP, which is independently associated with an increased risk of cardiovascular events.…”

Section: Structural Changesmentioning

confidence: 99%

Epidemiology, risk factors and management of cardiovascular diseases in IBD

Singh

Kullo

Pardi

et al. 2014

Nat Rev Gastroenterol Hepatol

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IBD is an established risk factor for venous thromboembolism. In the past few years, studies have suggested that patients with IBD might also be at an increased risk of coronary heart disease and stroke. The increased risk is thought to be similar to the level of risk seen in patients with other chronic systemic inflammatory diseases such as rheumatoid arthritis. The risk of developing these conditions is particularly increased in young adults with IBD, and more so in women than in men. Conventional cardiovascular risk factors are not over-represented in patients with IBD, so the increased risk could be attributable to inflammation-mediated atherosclerosis. Patients with IBD often have premature atherosclerosis and have biochemical and genetic markers similar to those seen in patients with atherosclerotic cardiovascular disease. The role of chronic inflammation in IBD-associated cardiovascular disease merits further evaluation. Particular attention should be given to the increased risk observed during periods of increased disease activity and potential modification of the risk by immunosuppressive and biologic therapies for IBD that can modify the disease activity. In addition, preclinical studies suggest that cardiovascular medications such as statins and angiotensin-converting enzyme inhibitors might also favourably modify IBD disease activity, which warrants further evaluation.

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“…Obesity, hypertension, diabetes, smoking, hyperlipidaemia, increased homocysteine levels, and chronic inflammatory diseases are all known to cause endothelial dysfunction (ED) (3)(4)(5)(6). In these conditions, the carotid intima-media thickness increases, and this increase is associated with increased rates of cardiovascular disease, peripheral artery disease, and stroke (3,6,7). In several studies, it has been shown that incidence of atherosclerosis, cerebrovascular disease, and venous embolism is higher among individuals with CD (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%