Downloaded from http://journals.lww.com/eurojgh by BhDMf5ePHKbH4TTImqenVJua3JJgqHHlDyUsG1CJ19CSOm6gYmnIC/MnRiGyBNLjRtVBpgRHFP0= on 04/11/2020 Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 0954-691X Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Original article DOI: 10.1097/MEG.0000000000001674 581 The role of coexisting cardiovascular disease on disease severity in patients with inflammatory bowel disease Aikaterini Mantaka a,b , Emmanouela Tsoukali a,c , Maria Fragkaki d , Konstantinos Karmiris d , Nikos Viazis c , Gerassimos J. Mantzaris c and Ioannis E. Koutroubakis b Introduction The role of chronic inflammation as a triggering factor for atherosclerotic cardiovascular disease (CVD) in sys- temic autoimmune diseases, such as rheumatoid arthri- tis and lupus erythematosus, is well established [1,2]. Inflammatory bowel diseases (IBD) consisting of Crohn’s disease (CD) and ulcerative colitis (UC) are character- ized by chronic relapsing-remitting or continuous course leading to chronic intestinal and systemic inflammation. Although subclinical markers of CVD, including inflam- matory mediators like CRP [3], or endothelial dysfunction indices, such as carotid intima-media thickness [4] and aortic pulse wave velocity [5] are increased among IBD patients, a strong link between IBD and cardiovascular risk has not been proven so far. The emerging role of gut microbiota and dysbiosis in both IBD [6] and CVD [7] raises even more questions on the possible association between these entities. Cohort studies and a recent meta-analysis have shown that factors such as age, sex, and clinical characteristics such as disease extent and disease activity may be impli- cated in the development of CVD [8–13], but robust data are lacking. In contrast to disease activity which reflects patient symptoms at a certain moment in time disease severity reflects the overall burden of disease since the diagnosis of IBD, including the impact of disease on patient’s symp- toms and daily activities, fatigue, social, and professional life, and also use of steroids or biologic agents, intestinal resections, and hospitalizations [14]. Therefore, patients with more severe disease are possibly at an increased risk for cardiovascular complications. Because there are no published data on the severity of IBD in patients with established concomitant CVD, we hypothesized that IBD patients with coexistence of CVD could have more severe disease compared to patients European Journal of Gastroenterology & Hepatology 2020, 32:581–587 Keywords: cardiovascular disease, disease severity, inflammatory bowel disease a Faculty of Medicine, University of Crete, Heraklion, b Department of Gastroenterology, University Hospital of Heraklion, Crete, c Department of Gastroenterology, General Hospital of Athens ‘Evangelismos-Ophthalmiatreion Athinon-Polykliniki’, Athens and d Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece Correspondence to Aikaterini Mantaka, MD, PhD, Department of Gastroenterology and Hepatology, University Hospital of Heraklion, P.O. BOX 1352, Heraklion 71100, Crete, Greece Tel: +30 2810 392356; fax: +30 2810 542085; e-mail: katmant@gmail.com Received 21 August 2019 Accepted 8 December 2019 Objectives: Chronic inflammation has been implicated in the pathogenesis of atherosclerosis and cardiovascular disease. Data linking the severity of inflammatory bowel disease to coexisting cardiovascular disease are scarce. The aim of the present study was to investigate whether inflammatory bowel disease patients with coexistent cardiovascular disease have more severe disease. Methods: We included 103 inflammatory bowel disease patients with coexisting cardiovascular disease compared to 206 age- and sex-matched inflammatory bowel disease patients without cardiovascular disease derived from three referral inflammatory bowel disease Centers. Traditional cardiovascular disease factors and parameters of inflammatory bowel disease severity were compared between the two groups. Results: Cardiovascular disease was diagnosed after the inflammatory bowel disease diagnosis in 56.6% of cases. No significant difference was found in the prevalence of surrogate markers of severity (inflammatory bowel disease-related surgeries, hospitalizations, biologics or immunosuppressants’ use, and persistent CRP elevation) between inflammatory bowel disease patients with and without cardiovascular disease. There was no difference between cardiovascular disease patients diagnosed before and after inflammatory bowel disease onset. All traditional risk factors (hypertension, dyslipidemia, smoking, obesity, diabetes mellitus) were significantly more common in cardiovascular disease patients. Cardiovascular disease patients had a trend for lower rates of multiple hospitalizations (16.5% vs. 24.3%, P = 0.05) and inflammatory bowel disease-related surgeries (P = 0.09). Conclusion: The inflammatory burden possibly plays a less important role in the development of cardiovascular disease in inflammatory bowel disease patients but future larger prospective studies are needed. Eur J Gastroenterol Hepatol 2020: 581–587 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.