Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Innsbruck, Austria.
Gastroenterology Unit, Peritox UMR I-0I, Amiens University and Hospital, Université de Picardie Jules Verne, Amiens, France.
J Intern Med. 2023 Dec;294(6):708-720. doi: 10.1111/joim.13735. Epub 2023 Oct 29.
Cardiovascular and thromboembolic risks are increasing in the population as a whole and therefore also in inflammatory bowel disease (IBD) patients. Obesity is a worldwide challenge also affecting the IBD population, and a causal association with Crohn's disease may exist. IBD itself, particularly when active, is also associated with a significant risk of thromboembolic and cardiovascular events such as myocardial infarction and stroke. Cardiovascular risk is also a significant consideration when using Janus kinase (JAK) inhibitors and sphingosine 1 phosphate (S1P) receptor modulators to treat IBD. JAK inhibitors - such as tofacitinib - are associated with several cardiovascular and venous thromboembolic risks, including hypertension and alterations in lipid profiles - specifically, increased LDL cholesterol and triglycerides - which may contribute to atherosclerosis and cardiovascular disease. S1P receptor modulators pose a slightly different set of cardiovascular risks. Initially, these drugs can cause transient bradycardia and atrioventricular (AV) block, leading to bradycardia. Moreover, they may induce QT interval prolongation, which increases the risk of life-threatening arrhythmias such as torsades de pointes. Some patients may also experience hypertension as a side effect. In this context, IBD healthcare providers need to be alert to the assessment of cardiovascular risk - particularly as cardiovascular events appear to be confined to specific patient groups with pre-existing risk factors. In addition, the potential for S1P modulator drug interactions requires a higher level of vigilance in patients with polypharmacy compared to biologics. Cardiovascular risk is not static, and updated assessment will need to become part of the routine in many IBD units.
心血管和血栓栓塞风险在整个人群中都在增加，因此在炎症性肠病（IBD）患者中也是如此。肥胖是一个全球性的挑战，也影响到 IBD 人群，而且可能与克罗恩病存在因果关系。IBD 本身，特别是在活动期，也与血栓栓塞和心血管事件（如心肌梗死和中风）的显著风险相关。在使用 Janus 激酶（JAK）抑制剂和鞘氨醇 1 磷酸（S1P）受体调节剂治疗 IBD 时，心血管风险也是一个重要的考虑因素。JAK 抑制剂 - 如托法替尼 - 与多种心血管和静脉血栓栓塞风险相关，包括高血压和脂质谱改变 - 特别是 LDL 胆固醇和甘油三酯升高 - 这可能导致动脉粥样硬化和心血管疾病。S1P 受体调节剂带来了一组略有不同的心血管风险。最初，这些药物会导致短暂性心动过缓和房室（AV）传导阻滞，导致心动过缓。此外，它们可能会引起 QT 间期延长，增加危及生命的心律失常（如尖端扭转型室性心动过速）的风险。一些患者也可能出现高血压作为副作用。在这种情况下，IBD 医疗保健提供者需要警惕心血管风险的评估 - 特别是因为心血管事件似乎仅限于具有先前存在的风险因素的特定患者群体。此外，与生物制剂相比，S1P 调节剂药物相互作用的可能性需要在接受多种药物治疗的患者中保持更高的警惕性。心血管风险不是静态的，许多 IBD 单位需要将更新的评估纳入常规。
