DAY 1 - Inflammatory Bowel Disease Subtype May Influence Risk for Atherosclerotic Cardiovascular Disease

People living with Crohn’s disease (CD) may have a more favorable cardiovascular risk profile than those with ulcerative colitis (UC), according to a retrospective study presented Monday at the ACG 2024 Annual Scientific Meeting in Philadelphia, Pennsylvania.

Recent studies have suggested that inflammatory autoimmune disorders predispose individuals to adverse cardiovascular events, which often occur at an earlier age than in the general population. Inflammatory bowel disease (IBD), a chronic disorder that causes inflammation of the gastrointestinal tract and can present with extra-intestinal manifestations in certain individuals, has been linked to an increased risk of incident atherosclerotic cardiovascular disease (ASCVD) events (Nasir K et al. Am J Prev Cardiol 2022;9:100316).

The local and systemic inflammation experienced by people with CD and UC likely plays a significant role in the development of atherosclerosis, along with traditional cardiovascular risk factors. In a retrospective cohort study conducted at the Creighton University Medical Center, in Omaha, Nebraska, researchers looked into how the different subtypes of IBD shape the risk for cardiovascular events. “The purpose of our study was to assess the differences in ASCVD risk in UC versus CD as well as elucidate whether this risk is influenced by particular therapies for IBD,” said lead author Clive J. Miranda, DO, MSc, who presented the findings during a poster session. The study included nearly 400 patients with biopsy-confirmed IBD who were treated at a tertiary care center from January 2022 to December 2023. The participants, who were diagnosed with CD (59%) or UC (41%), were subcategorized into low (<10%), moderate (10-20%), and high (>20%) ASCVD risk groups. The presence of cardiometabolic comorbidities, the participants’ demographic characteristics, and the types of therapy they received for IBD were also factored into the sub-analyses.

While the results showed a significant association between ASCVD and IBD, a greater proportion of the participants with a low risk for ASCVD had CD (62.5%) rather than UC (37.5%). The type of therapy did not influence the risk for ASCVD events, however, the 10-year ASCVD risk was much higher for untreated participants than for those who received therapies for IBD. 
“Patients with CD have a significantly lower 10-year ASCVD risk compared to UC patients,” Miranda noted. “[We found that] IBD therapy types do not influence the degree of risk but patients not on therapy have a significantly higher 10-year ASCVD risk than those who are [being treated].”

While primary CVD prevention guidelines emphasize lifestyle modifications such as adequate nutrition and physical activity, treatment algorithms and assessment parameters for individuals living with CD or UC continue to evolve as research generates a more detailed picture of the cardiovascular risk profiles of people with different IBD subtypes.