Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut–Heart Connection

Abstract

(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle–Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.

Acute myocardial infarction complicating acute ulcerative colitis: A clinical conundrum

“…A systematic review by Jaaouani et al, had reported that the risk of ACS increases significantly with acute active flares, in addition to prolonged periods of active disease. 6 On the other hand, the risk of ACS is lower in patients who are in F I G U R E 1 Coronary angiography shows thrombus in all three coronary arteries including ramus intermedius. remission phase of the disease.…”

“…This finding is supported in the literature by the various authors. A systematic review by Jaaouani et al, had reported that the risk of ACS increases significantly with acute active flares, in addition to prolonged periods of active disease 6 . On the other hand, the risk of ACS is lower in patients who are in remission phase of the disease 6 .…”

“…A systematic review by Jaaouani et al, had reported that the risk of ACS increases significantly with acute active flares, in addition to prolonged periods of active disease 6 . On the other hand, the risk of ACS is lower in patients who are in remission phase of the disease 6 . A cross‐sectional observational study on the Egyptian population also showed that the risk of ASCVD is higher in IBD patients, particularly during active disease 7 .…”

“… 6 On the other hand, the risk of ACS is lower in patients who are in remission phase of the disease. 6 A cross‐sectional observational study on the Egyptian population also showed that the risk of ASCVD is higher in IBD patients, particularly during active disease. 7 The similar observation was also noticed by Danish nationwide cohort study, where IBD flares were associated with an increased risk of MI, stroke, and even cardiovascular death.…”

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

“…In the study conducted by Jaaouani et al [ 38 ] the use of aminosalicylates, immune modifiers, and biologic therapies did not affect acute coronary syndrome events. However, exposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD [ 39 ].…”