Bridging the gut and the heart-Exploring pathophysiology, risk factors, and therapeutic implications of cardiovascular disease in inflammatory bowel disease

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic systemic immune dysregulated disorder affecting the gastrointestinal tract that often has extraintestinal manifestations. Limited data exist on the cardiovascular (CV) implications of IBD, but a higher prevalence of CV disease (CVD) has been observed compared to the general population, resulting in increased mortality risk. This review examines the pathophysiology and risk factors linking IBD to CVD, highlighting several key mechanisms: The “lipid paradox” in active IBD, arterial stiffness and endothelial dysfunction, proinflammatory cytokine activity, gut microbiota dysbiosis, and drug-induced myocardiopathy. The main findings include information about IBD patients exhibiting a higher incidence of CVD compared to the general population, independent of traditional risk factors. Chronic inflammation, altered lipid profiles, and gut microbiome imbalances play a significant role in heightened CV risk. Routine CV risk assessment should be considered during clinical assessment, to integrate into IBD management. Anti-inflammatory therapies may reduce CVD risk, while careful consideration is needed for drugs with potential CV side effects. Further research is required to understand the complex interplay between IBD and CVD, particularly regarding the impact of novel therapies and lifestyle interventions on long-term CV outcomes in IBD patients.