Inflammation and Aortic Stiffness: An Individual Participant Data Meta‐Analysis in Patients With Inflammatory Bowel Disease

Abstract

BackgroundThe recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased despite the low prevalence of traditional cardiovascular risk factors. We aimed to test whether inflammation is associated with aortic stiffening in this setting after adjustment for major confounders and to perform subgroup analyses.Methods and ResultsA systematic literature search for aPWV in inflammatory bowel disease was performed using PubMed, Scopus, Web of Science, and Google Scholar databases (last accessed May 7, 2017). Inclusion criterion was peer‐reviewed publications on clinical studies reporting original data. This study followed the Preferred Reporting Items for Systematic Review and Meta‐Analyses of individual participant data 2015 guidelines. Data were provided for 4 cohorts in 3 countries (151 participants with ulcerative colitis, 159 with Crohn's disease, and 227 control patients). Using aPWV, cohort‐specific z scores were calculated after loge‐transform and combined in meta‐analysis to form pooled effects using a random‐effects model. Compared with controls, aPWV was increased in patients with Crohn's disease (mean difference 0.78 z score; 95% confidence interval, 0.56–1.00 z score [P<0.001]) and ulcerative colitis (mean difference 0.75 z score; 95% confidence interval, 0.52–0.97 z score [P<0.001]). In an outlier‐robust multivariate linear regression model adjusted for prespecified confounders, aPWV was associated with disease duration (years, β=0.05 z score; 95% confidence interval, 0.02–0.08 z score [P<0.001]) and white blood cell count (billion cells/L, β=0.07 z score; 95% confidence interval, 0.02–0.11 z score [P=0.002]) but not with markers of acute inflammation (C‐reactive protein and erythrocyte sedimentation rate), cardiovascular risk factors, and therapy.ConclusionsThe increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation.Clinical Trial Registration URL: http://www.crd.york.ac.uk. Unique identifier: PROSPERO 2016: CRD42016053070.

Serum Catestatin Levels and Arterial Stiffness Parameters Are Increased in Patients with Inflammatory Bowel Disease

“…Interesting findings were reported by Zanoli et al in a recently published individual participant data meta-analysis, indicating that PWV was associated with disease duration and white blood cell count [63]. On contrary, the present research did not reveal any association between disease duration and PWV but showed significant positive correlation of white blood cell and PWV which is in accordance to previously mentioned findings.…”

Increased arterial stiffness – similar findings in patients with inflammatory bowel disease without prior hypertension or diabetes and in patients with well-controlled hypertension

“…Interestingly, these patients had not only increased arterial stiffness of large arteries but also AIx. In contrast to previous reports [25], we have not found associations between active disease and increased arterial stiffness but only the duration of the disease as a marker of prolonged inflammation independent of already established risk factors which is similar to the meta-analysis by Zanoli et al [26]. Different Crohn's disease phenotypes and ulcerative colitis localization were not associated with increased PWV.…”

Regional Arterial Stiffness in Patients with Inflammatory Bowel Disease

“…Взаимосвязь ВЗК, их клинических особенностей и сосудистой жесткости становилась предметом изучения в ряде клинических исследований, результаты которых, однако, крайне неоднородны. В метаанализе 2017 года, проведенном L. Zanoli et al, было установлено, что пациенты с БК (n = 159) и ЯК (n = 151) отличались статистически значимо большими значениями СПВкф в сравнении с группой контроля (n = 227) [13]. При этом факторами, независимо ассоциированными с увеличением СПВкф у пациентов с ВЗК, являлись длительность заболевания и количество лейкоцитов.…”

“…пациенты с ВЗК в сравнении с контролем отличались статистически значимо большими значениями толщины комплекса интима-медиа, СПВкф и индекса аугментации [14]. В ряде исследований не было установлено значимого увеличения сосудистой жесткости у пациентов с ВЗК [13].…”

“…По нашему мнению, описывать и интерпретировать атерогенные эффекты воспаления (оцениваемые, например, по уровню вчСРБ) целесообразно не только в рамках абсолютных величин того или иного маркера воспаления в данный момент, но и в рамках кумулятивной длительности воспалительного процесса. Ограниченное значение оценки хронического системного воспаления по однократному определению маркеров воспаления подчеркивают также L. Zanoli и соавт., что свидетельствует о важности альтернативных подходов к данному вопросу [13]. Кроме того, в проведенном нами исследовании по результатам корреляционного анализа значения вчСРБ обратно коррелировали с возрастом пациентов, при этом наибольшие значения вчСРБ наблюдались у пациентов младше 28 лет: 31,8 (20,6-36,0) мг/л у лиц младше 28 лет против 2,06 (0,56-2,87) мг/л у лиц старше 28 лет (p = 0,001).…”