Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Penn.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Am J Med. 2022 Dec;135(12):1453-1460. doi: 10.1016/j.amjmed.2022.08.012. Epub 2022 Sep 2.
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.
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.
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).
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.
新出现的数据表明，患有慢性炎症性疾病的患者，包括炎症性肠病，更有可能发展为动脉粥样硬化性心血管疾病、心力衰竭和心房颤动。本文旨在综述这些关联的证据。
使用关键词，包括炎症性肠病、克罗恩病、溃疡性结肠炎、动脉粥样硬化性心血管疾病、冠心病、心血管疾病、心房颤动、心力衰竭和早发性冠心病，从创建到 2022 年 1 月在 PubMed 上进行搜索。综述并总结了相关文献，包括回顾性/前瞻性队列研究、临床试验、荟萃分析和指南。
溃疡性结肠炎和克罗恩病均与动脉粥样硬化性心血管疾病、脑血管意外、早发性冠心病和心房颤动风险增加相关。溃疡性结肠炎与心力衰竭风险增加相关。心房颤动发生在炎症性肠病发作和持续活动期间，但不在缓解期间。炎症性肠病与动脉粥样硬化性心血管疾病相关的机制假设包括共同的危险因素（即肥胖、糖尿病、吸烟、饮食）和病理生理学（肠道微生物组功能障碍）或炎症性肠病本身或其治疗的不良影响（即慢性炎症、血脂异常、血小板增多、类固醇）。
炎症性肠病与动脉粥样硬化性心血管疾病、心力衰竭和心房颤动的风险增加相关。需要多学科团队，包括胃肠病学家和心脏病学家，以优化炎症性肠病和相关心脏病患者的治疗。
