Am J Med. 2022 Dec;135(12):1453-1460. doi: 10.1016/j.amjmed.2022.08.012. Epub 2022 Sep 2.

Bing Chen ¹, Lauren V Collen ², Craig Mowat ³, Kim L Isaacs ⁴, Siddharth Singh ⁵, Sunanda V Kane ⁵, Francis A Farraye ⁶, Scott Snapper ⁷, Hani Jneid ⁸, Carl J Lavie ⁹, Chayakrit Krittanawong ¹⁰

Author information

¹Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Penn.

²Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Mass.

³Gastrointestinal Unit, Ninewells Hospital & Medical School, Dundee, UK.

⁴University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, NC.

⁵Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

⁶Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Fla.

⁷Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Division of Gastroenterology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Mass.

⁸John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Houston.

⁹John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, La.

¹⁰Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY. Electronic address: Chayakrit.Krittanawong@nyulangone.org.

Abstract

Background: Emerging data showed patients with chronic inflammatory disorders, including inflammatory bowel disease, are more likely to develop atherosclerotic cardiovascular diseases, heart failure, and atrial fibrillation. This article aims to review the evidence of those associations.

Methods: PubMed was searched from inception to January 2022 using the keywords, including inflammatory bowel diseases, Crohn disease, ulcerative colitis, atherosclerotic cardiovascular disease, coronary artery disease, cardiovascular disease, atrial fibrillation, heart failure, and premature coronary artery disease. Relevant literature, including retrospective/prospective cohort studies, clinical trials, meta-analyses, and guidelines, were reviewed and summarized.

Results: Both ulcerative colitis and Crohn disease are associated with an increased risk of atherosclerotic cardiovascular diseases, cerebrovascular accidents, premature coronary artery disease, and atrial fibrillation. Ulcerative colitis is associated with an increased risk of heart failure. The increased atrial fibrillation occurred during inflammatory bowel disease flares and persistent activity but not during periods of remission. Hypotheses for the mechanism underlying the association of inflammatory bowel disease and atherosclerotic cardiovascular diseases include shared risk factors (ie, obesity, diabetes, smoking, diet) and pathophysiology (gut microbiome dysfunction) or adverse effects from inflammatory bowel disease itself or its treatment (ie, chronic inflammation, dyslipidemia, thrombocytosis, steroids).

Conclusion: Inflammatory bowel disease is associated with an increased risk of atherosclerotic cardiovascular diseases, heart failure, and atrial fibrillation. A multidisciplinary team with gastroenterologists and cardiologists is needed to optimize the care for patients with inflammatory bowel disease and associated cardiac diseases.