Cardiovascular Manifestations of Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Preventive Strategies

Abstract

Inflammatory bowel disease (IBD) refers to a group of chronic inflammatory diseases that targets mainly the gastrointestinal tract. The clinical presentation of IBD includes both gastrointestinal manifestations and extraintestinal manifestations (EIM). The reported cardiovascular manifestations in IBD patients include pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, atrioventricular block, heart failure, endocarditis, valvulopathies, and Takayasu arteritis. The aim of this article is to review the available literature about the possible pathogenic mechanisms and determine preventive measures capable of reducing the incidence and severity of the cardiovascular manifestations. In IBD patients, the incidence of cardiovascular manifestations is low, but higher than that in the general population. Therefore, clinicians should pay attention to any new modification that might indicate cardiovascular involvement in IBD patients, and they should consider chronic inflammatory diseases in patients with cardiac conditions without an evident cause. Considering the role of inflammation in the development of cardiovascular manifestations, the management should include prevention of flares and maintenance of remission for as long as possible. Preventive measures should also include active screening and strict control of the cardiovascular risk factors in all IBD patients.

Pro-Atherogenic Inflammatory Mediators in Inflammatory Bowel Disease Patients Increase the Risk of Thrombosis, Coronary Artery Disease, and Myocardial Infarction: A Scientific Dilemma

“…A large retrospective study evaluating the efficacy of statins against inflammation illustrated an 18% decrease in the initiation of corticosteroid therapy. Routinely prescribed cardiovascular medications like statins showed decreased disease activity in IBD, suggesting further evidence on the link between IBD and MI [8,10,[33][34][35][36].…”

Therapies in Inflammatory Bowel Disease Patients with Extraintestinal Manifestations

“…In particular, interstitial pneumonitis has been suggested 20-55% of IBD patients [131], the most frequent remaining drug induced (5-ASA compounds, methotrexate, or anti-TNF alpha agents) [132] and infections. IBD patients are at increased risk of cardiovascular events (mainly ve-Digestion 2020;101(suppl 1):83-97 DOI: 10.1159/000502816 nous and arterial thromboembolism, myocardial infarction) which are more linked to the chronic inflammatory pattern of the disease and less to very rare associated cardiovascular diseases [25,133]. Finally, pancreatitis associated with IBD could also be considered as EIM after inclusion of biliary pancreatitis, drug-induced (i.e., azathioprine, amino salicylates) or autoimmune cause [134,135].…”

Genetic Basis of Myocarditis: Myth or Reality?

“…Etiologic hypotheses include systemic autoimmune diseases [164][165][166][167][168], drug toxicity [169], infections [170][171][172], and complex combination of autoimmunity, infections and drug toxicity [173]. Infections reported in GCM include coxsackie B2 virus [170], parvovirus B19 [171], HCMV [172] and HIV1 infection [173][174][175][176][177][178][179][180][181][182][183][184]. In most cases, GCM is an isolated entity, while in about one-fifth of cases GCM occurs in association with autoimmune/immune-mediated diseases (Table 4.7), infections, drug toxicity, or syndromes such as immune reconstitution inflammatory syndrome (IRIS) in patients undergoing highly active antiretroviral therapy (HAART) against human immunodeficiency virus type 1 (HIV-1) [173,184,185] or even in patients taking common medications such as amoxicillin [183].…”