Endothelial Dysfunction and Arterial Stiffness in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract

Population-based studies have suggested that patients with inflammatory bowel disease (IBD) might be at an increased risk for cardiovascular diseases. A meta-analysis was performed on clinical studies to evaluate endothelial function, arterial stiffness, and carotid intima-media thickness (cIMT) in patients with IBD, after searching PubMed, Embase, Cochrane library, and Web of Science databases. A random-effects model was used to allow for the pooling of studies and for determination of the overall effect. After exclusion, a total of 41 eligible studies with 2330 patients with IBD and 2032 matched controls were identified and included for the analysis. It was found that cIMT was significantly increased in patients with IBD as compared with that in matched controls (Cohen’s d: 0.63; 95% CI: 0.34, 0.93; I2 = 91.84%). The carotid–femoral pulse wave velocity was significantly higher in patients with IBD compared to that in matched controls (Cohen’s d: 0.76; 95% CI: 0.54, 0.98; I2 = 70.03%). The augmentation index was also significantly increased in patients with IBD compared to matched control subjects (Cohen’s d: 0.35; 95% CI: 0.08, 0.63; I2 = 61.37%). Brachial artery flow-mediated dilatation was significantly decreased in patients with IBD than that in matched controls (Cohen’s d: −0.73; 95% CI: −1.10, −0.36; I2 = 81.02%). Based on the meta-analysis, it was found that patients with IBD exhibit significant endothelial dysfunction, increased arterial stiffness, and cIMT. Thus, patients with IBD may benefit from aggressive risk stratification for cardiovascular diseases.

Recovery of Ischemic Limb and Femoral Artery Endothelial Function Are Preserved in Mice with Dextran Sodium Sulfate-Induced Chronic Colitis

“…Studies have demonstrated that endothelial cell dysfunction, as reflected by decreases in flow-mediated dilatation and pulse arterial tonometry indices, is present in patients with IBD [ 8 , 9 ]. Consistent with this, our recent meta-analysis showed that patients with IBD were significantly associated with endothelial cell dysfunction, increased arterial stiffness, and carotid intima-media thickness [ 10 ].…”

“…Chronic inflammation has been known to be associated with endothelial dysfunction [ 33 ]. Our recent meta-analysis demonstrated that patients with IBD were significantly associated with endothelial cell dysfunction, increased arterial stiffness, and carotid intima-media thickness [ 10 ]. In the present study, we observed that plasma TNF-α, IL-6, and IL-17 were significantly increased in mice with colitis.…”

Incidence and disease‐related risk factors for cerebrovascular accidents in patients with inflammatory bowel diseases: A systematic review and meta‐analysis

“…25 All these factors were strong predictors of future cardiovascular accidents, including coronary accidents and CVAs. 25,26 These results indicated that IBD patients might have a higher risk of developing CVA than the general population. However, the results of previous metaanalyses were controversial.…”

“…A meta‐analysis of 41 studies showed that patients with IBD exhibit significant endothelial dysfunction, increased arterial stiffness, and carotid intima‐media thickness 25 . All these factors were strong predictors of future cardiovascular accidents, including coronary accidents and CVAs 25,26 . These results indicated that IBD patients might have a higher risk of developing CVA than the general population.…”

Arterial Stiffness—What Do We Know about It and What Do We Expect from This Biomarker?

“…Many studies have reported different physiological and pathophysiological conditions associated with increased arterial stiffness [ 1 ]. For instance, it has been shown that arterial stiffness is increased not only in atherosclerotic cardiovascular disease but also in systemic sclerosis, in autoimmune diseases characterized by endothelial dysfunction and fibrosis of skin and visceral organs [ 2 ], in inflammatory bowel disease which is accompanied with endothelial dysfunction [ 3 ] as well as in subclinical and overt hypothyroidism, hyperthyroidism and in primary hyperparathyroidism. It seems that levothyroxine replacement therapy causes an improvement in arterial stiffness in patients with hypothyroidism and that arterial stiffening is reversed by parathyroidectomy in primary hyperparathyroidism [ 4 ].…”