Lipid-lowering drug targets influence inflammatory bowel disease through gut microbiota and inflammatory cytokines.

Patients with dyslipidemia are at higher risk for inflammatory bowel disease (IBD), yet the impact of lipid-lowering medications on IBD remains unclear. This study investigates the causal relationship between lipid-lowering drug target and IBD, with a focus on the roles of gut microbiota and inflammatory cytokines. Genetic variants associated with lipid-lowering drug targets were extracted from the Global Lipids Genetics Consortium, whereas summary statistics for IBD, Crohn's disease (CD), and ulcerative colitis were sourced from the International Inflammatory Bowel Disease Genetics Consortium. Drug-target Mendelian randomization analysis revealed that inhibiting angiopoietin-like protein 3 increased the risk of IBD and CD, whereas inhibition of apolipoprotein C-III (APOC3) heightened the risk of CD. Conversely, enhancement of LPL and LDL receptor reduced the risk of IBD and CD. Mediation analysis demonstrated that gut microbiota and inflammatory cytokines partially mediated these effects, with specific pathways such as Lachnospiraceae FCS020 (17.26%) for APOC3 and Clostridium sensu stricto 1 (20.12%) for LPL accounting for significant portions of the effects. These findings suggest that lipid-lowering drugs targeting angiopoietin-like protein 3 and APOC3 may increase the risk of IBD, whereas those targeting LPL and LDL receptor may reduce the risk. The results highlight potential for repurposing lipid-lowering drugs for IBD prevention and warrant future clinical trials to explore these targets further.