The Present and Future
JACC Review Topic of the Week
Inflammatory Bowel Disease and Atherosclerotic Cardiovascular Disease: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2020.10.027Get rights and content
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Highlights

  • IBD affects 6.8 million people worldwide and 3 million in the United States.

  • Patients with IBD have an increased risk for ASCVD, yet targeted preventive strategies remain underdeveloped.

  • Mechanisms underlying this association include overlapping risk factors, inflammation, microbiome abnormalities, endothelial dysfunction, thrombogenicity, lipid dysfunction, and the impact of corticosteroids.

  • Prevention, systematic detection and aggressive management of cardiovascular risk factors are key components of management for these patients.

  • IBD-modifying therapies have shown promise in reducing ASCVD risk, but more research is needed to translate these into evidence-based practice.

Abstract

Chronic inflammatory diseases including human immunodeficiency virus infection, psoriasis, rheumatoid arthritis, and systemic lupus erythematosus predispose to atherosclerotic cardiovascular disease (ASCVD). Inflammatory bowel disease (IBD) is a common chronic inflammatory condition, and the United States has the highest prevalence worldwide. IBD has so far been overlooked as a contributor to the burden of ASCVD among young and middle-age adults, but meta-analyses of cohort studies suggest that IBD is an independent risk factor for ASCVD. This review discusses the epidemiological links between IBD and ASCVD and potential mechanisms underlying these associations. ASCVD risk management of patients with IBD is challenging because of their young age and the inability of current risk scores to fully capture their increased risk. The role of IBD in current primary prevention guidelines is evaluated, and strategies for enhanced ASCVD risk reduction in patients with IBD are outlined. Finally, the authors discuss knowledge gaps and future research directions in this innovative field.

Key Words

atherosclerosis
cardiovascular disease
inflammation
inflammatory bowel disease
prevention

Abbreviations and Acronyms

ASCVD
atherosclerotic cardiovascular disease
CD
Crohn’s disease
CHD
coronary heart disease
CI
confidence interval
IBD
inflammatory bowel disease
IL
interleukin
RR
relative risk
Th
T helper
TNF
tumor necrosis factor
UC
ulcerative colitis

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

Drs. Cainzos-Achirica and Glassner contributed equally as joint first authors.