Vinculum of Cardiovascular Disease and Inflammatory Bowel Disease: A Narrative Review

Abstract

Inflammatory bowel disease (IBD), comprising of ulcerative colitis (UC) and Crohn's disease (CrD), is a chronic relapsing-remitting inflammation of the bowel with extraintestinal involvement. Numerous studies published in the last decade have underlined the dangerous cardiovascular disease (CVD) outcomes of IBD, such as ischemic heart disease, heart failure, and stroke, and the need for better therapeutic and prognostic strategies. This article elucidated the pathological web of mechanisms that link IBD with CVD, such as immune dysregulation, endothelial dysfunction, arterial stiffness, and dysbiosis, with a comprehensive review of clinical studies standing for and against the notion in pediatric and adult populations. The current treatment and prevention aim at disease remission and dietary strategies shown to reduce the CVD risk. Exploration of other supplemental preventive and treatment methods, especially during active flares of disease, to reduce the risk of arterial thromboembolic disease (ATED) is the need of the hour.

Long-term Risk of Stroke in Patients With Inflammatory Bowel Disease

“…Stroke is a leading cause of disability and death worldwide with incidence and prevalence increased by 70% and 85%, respectively, during the past 30 years, 4 which can be broadly classified into ischemic (predominant) and hemorrhagic strokes. The increased risk of stroke in patients with IBD has been reported in previous studies with chronic systemic inflammation, 5,6 endothelial dysfunction, 7 arterial stiffness, 7 and shifted microbiota-gut-brain axis 8,9 proposed as the underlying mechanisms.…”

“…8 Chronic inflammation induces endothelial dysfunction, promotes plaque formation, platelet activation, and aggregation and contributes to atherosclerosis and arterial stiffness. 7 Disrupted microbiota-gut-brain-axis has been linked to neurodevelopmental disorders, neurodegenerative diseases, and stroke through modulating blood-brain barrier formation, myelination, microglia maturation, and neuroinflammation. 8 Moreover, patients with IBD are more likely to acquire prothrombotic factors, such as surgery, 45 immobilization due to fracture, 47 and steroid therapy, 2 which in turn substantially increase the risk of developing blood clots.…”

Advancements in Inflammatory Bowel Disease: A Narrative Review of Diagnostics, Management, Epidemiology, Prevalence, Patient Outcomes, Quality of Life, and Clinical Presentation

“…Furthermore, advances in surgical techniques, such as minimally invasive procedures and laparoscopy, have resulted in better outcomes for patients requiring surgical intervention. Again, new research has shed light on IBD's extra-intestinal symptoms, such as its neurological, cardiovascular, and dermatological implications [5][6][7]. These discoveries have highlighted the significance of a multidisciplinary approach to IBD care, integrating gastroenterologists, rheumatologists, dermatologists, and other experts to address the disease's various clinical presentations.…”