Atherosclerotic cardiovascular diseases in inflammatory bowel diseases: to the heart of the issue

Abstract

Atherosclerotic cardiovascular disease and stroke are the leading causes of morbidity and mortality worldwide. Along to the traditional risk factors for these diseases, chronic inflammation is known to be an important player in accelerating the process of atherosclerosis, which can result in an increased incidence of arterial thromboembolic events. As in other chronic inflammatory diseases, in the past few years, several studies suggested that subjects affected by inflammatory bowel diseases (IBD) may also be at an incremented risk of atherosclerotic disease, especially during the periods of disease's flare. Therefore, IBD treatment may assume an important role for achieving both disease remission and the control of the atherosclerotic risk. In this article we aimed to perform a comprehensive review on evidence on the increased risk of arterial thromboembolic events in patients affected by IBD and discuss the potential role of IBD therapy in reducing this risk.

Increased LL37 in psoriasis and other inflammatory disorders promotes LDL uptake and atherosclerosis

“…We also show that in mice, transgenic expression of LL37 resulted in increased development of atherosclerotic plaques. Given that LL37 levels are increased in chronic inflammatory disorders such as psoriasis, this may explain the increased risk of atherosclerotic disease in patients with inflammatory skin diseases ( 3 – 6 , 8 – 11 , 59 , 60 ).…”

“…In a large population-based cohort study, the HR of the risk of cardiovascular mortality in patients with severe psoriasis after adjustment was made for major cardiovascular risk factors was 1.57 (95% CI 1.26–1.96), which was even higher than that observed with hypertension and smoking ( 6 ). In addition to disorders of skin inflammation, chronic inflammatory disorders of other organ systems such as inflammatory bowel diseases (IBD) and rheumatoid arthritis (RA) also have an increased risk of cardiovascular comorbidities ( 8 – 14 ). Despite the high prevalence of these inflammatory diseases and their clinical effect on cardiovascular disease, mechanistic insights into why such chronic inflammation is associated with an increased risk of atherosclerosis remains elusive.…”

Cardiovascular implications of inflammatory bowel disease: An updated review

“…Adequate treatment of underlying IBD with the aim to achieve and maintain remission is important. Additionally, the patients should be screened for atherosclerotic risk factors such as obesity, smoking, hypertension, diabetes, dyslipidaemia and positive family history[ 144 ]. Definitive role of statins in IBD is controversial, but statins in addition to the lipid lowering function have pleiotropic effects, including modulation of the immune system[ 145 , 146 ].…”