Research has linked ulcerative colitis (UC) to an increased risk of heart disease, including heart attack and stroke. Some UC treatments may help reduce the risk of heart problems, though more research is necessary.
UC refers to chronic inflammation in the inner lining of the large intestine. People with UC may also develop inflammation in other parts of the body.
Both UC and Crohn’s disease are types of chronic inflammatory bowel disease (IBD). Recent researchTrusted Source suggests that people with IBD have an increased risk of cardiovascular disease, such as heart attack and stroke.
How does UC affect the risk of cardiovascular disease?
When the authors of a 2018 review pooled the results of past studies, they found that UC was associated with a:
1.15-fold increased risk of coronary heart disease
1.13-fold increased risk of heart attack
1.16-fold increased risk of stroke
The authors of a 2020 review in the Journal of the American College of Cardiology (JACC) also concluded that people with IBD have a two times greater risk of venous thromboembolism (VTE) than the general population.
VTE occurs when a blood clot forms in a deep vein, usually in the leg or pelvis. This clot may break free and travel through the bloodstream to the lungs. This is known as a pulmonary embolism. It can also block blood flow to the lungs, which can result in death.
“We need to spread more education about the risk of cardiovascular disease in people with IBD, so they’re aware that UC can contribute to this problem,” Dr. Preetika Sinh, an assistant professor of gastroenterology at the Medical College of Wisconsin in Milwaukee, told Medical News Today.
Does UC increase the risk more in some people than in others?
Observational studies have found that the risk of a cardiovascular event in people with IBD is higher during an active flare of the condition, report the authors of the review in the JACCTrusted Source.
“It’s also higher during the first year after [IBD] diagnosis, a period during which there are more flares and the disease is more active,” lead author Dr. Miguel Cainzos-Achirica, M.P.H., Ph.D., told MNT. He is the associate director of research in preventive cardiology at the Houston Methodist Academic Institute in Texas.
Cardiovascular disease is generally more common in people ages 65 years and older. In people with IBD, the risk appears to be increased most in younger people.
“In a French cohort studyTrusted Source, the highest risk of acute arterial events was seen in [people] younger than 55, within the 3 months preceding or following hospitalization for IBD,” said Dr. Aline Charabaty Pishvaian. She is the clinical director of gastroenterology and the director of the Inflammatory Bowel Disease Center at the Sibley Memorial Hospital in Washington, D.C.
IBD also appears to increase cardiovascular risk more in women than in men.
Research suggests that people with IBD are also at greater risk of other chronic inflammatory conditions, such as psoriasis and rheumatoid arthritisTrusted Source. Scientists have independently linked many of these conditions to an increased risk of cardiovascular disease.
Why is UC associated with increased cardiovascular risk?
More research is necessary to learn why people with UC have increased cardiovascular risk. Experts believe that chronic inflammation plays an important role.
According to a review of studies in the journal Oxidative Medicine and Cellular Longevity, people with IBD are less likely to have traditional risk factors for cardiovascular disease, such as obesity, high blood pressure, or diabetes. However, people with IBD are at increased risk of atherosclerosis.
Atherosclerosis refers to the buildup of plaque in the arteries. It raises the risk of heart attack and stroke.
The researchers linked chronic inflammation in IBD to structural changes in blood vessel walls and arterial stiffness. Both of these factors may, in turn, increase the risk of atherosclerosis.
When inflammation affects the lining of blood vessels, it may contribute to narrowed arteries and the buildup of plaque, report researchers in the journal Clinical ScienceTrusted Source.
Inflammation also promotes the formation of blood clots. A blood clot may block an artery in the:
lungs, causing a pulmonary embolism
heart, causing heart attack
brain, causing stroke
How do UC treatments affect cardiovascular risk?
Scientists need to conduct more research to learn how different UC treatments affect the risk of cardiovascular disease.
“Do any treatments for UC raise or lower the risk of cardiovascular events? We don’t have a clear answer yet,” said Dr. Sinh.
The American Gastroenterological Association recommends the following treatments for the long-term management of moderate-to-severe UC:
antitumor necrosis factor (TNF) agents, such as:
infliximab (Remicade)
adalimumab (Humira)
golimumab (Simponi)
vedolizumab (Entyvio), which is an integrin inhibitor
ustekinumab (Stelara), which is an interleukin 12/23 inhibitor
tofacitinib (Xeljanz), which is a Janus kinase inhibitor
Treatment with one of these medications may help reduce disease activity, limit the frequency of flares, and decrease the symptoms of UC.
These medications also decrease the inflammation that experts believe is involved in cardiovascular disease. Some research suggests that anti-TNF medications might decrease cardiovascular risk in people with IBD.
A recent national database studyTrusted Source in France found that people with IBD were less likely to have an acute arterial event if they took anti-TNF agents. The benefits of anti-TNF agents appeared to be greater for people with Crohn’s disease than those with UC.
A 2021 cohort studyTrusted Source also associated the use of anti-TNF agents with greater reductions in cardiovascular risk in people with Crohn’s disease than those with UC.
“I think what we need is more prospective studies, with disease activity and medication assessment, to get a better picture of what would benefit our patients the best,” said Dr. Sinh.
Doctors may also prescribe short-term treatment with corticosteroids during a flare of UC to help bring the condition into remission. However, prolonged use of these medications may actually raise the risk of cardiovascular disease in people with chronic inflammatory conditions, suggests research in the journal PLOS Medicine.
Assessing cardiovascular risk
The authors of the JACC review described potential approaches for assessing and managing cardiovascular risk in people with IBD.
“We recommend a team approach to the assessment of cardiovascular risk and timely detection of cardiovascular factors in these [people], with the gastroenterologist and cardiologist working together to screen for risk factors and optimize their management,” said Dr. Cainzos-Achirica.
Doctors typically assess cardiovascular risk using clinical risk calculators based on traditional cardiovascular risk factors. More research is necessary to learn how factors such as UC disease duration and activity affect the risk.
Current guidelines from the American College of Cardiology and American Heart Association (AHA) do not specifically address UC. However, they do note that chronic inflammatory conditions increase cardiovascular risk.
Managing cardiovascular risk
Depending on a person’s cardiovascular risk factors, a doctor may prescribe statin therapy. Statins are cholesterol-lowering medications that reduce the risk of heart attack and stroke.
“Current U.S. guidelines for the primary prevention of cardiovascular disease recommend consideration of preventive statin therapy in people with chronic inflammatory conditions if they have an intermediate risk of cardiovascular events,” said Dr. Cainzos-Achirica.
“Although not explicitly stated in the guidelines, we believe this recommendation also applies to [people] with UC,” he continued.
Doctors often also prescribe one or more of the following to manage cardiovascular risk factors:
medications to lower blood sugar, blood cholesterol, or blood pressure
counseling to help the person quit smoking, if applicable
dietary changes, including eating a variety of fiber-rich foods such as whole grains, legumes, vegetables, fruits, and nuts
changes to exercise routines or other habits
People with UC often limit high fiber foods during a flare to ease cramps and diarrhea, said Dr. Charabaty Pishvaian. They may also find it challenging to exercise during a flare due to fatigue or disruptive bowel symptoms, she added.
Taking medication to control inflammation and symptoms may allow people with UC to eat more varied diets and stay active.
“As we are discussing our goals of care and remission in UC, it is important to include being able to go back to a healthy diet and physical activity,” Dr. Charabaty Pishvaian said.
The takeaway
People with UC and other types of IBD have an increased risk of cardiovascular disease, including heart attack and stroke.
Cardiovascular disease may affect people with IBD at a younger age than average. The risk is particularly heightened in women and people experiencing an active flare of IBD.
Chronic inflammation may partly account for this increased risk. Some evidence suggests that prolonged corticosteroid use may also contribute.
Gastrointestinal specialists and cardiologists may work together to identify and manage cardiovascular risk factors. They may recommend medications, lifestyle changes, or other treatments.
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