Inflammatory Bowel Disease Linked to Increased Risk of VTE, CVD, and HF

Inflammatory bowel disease (IBD) is associated with a 2.5-fold increase of venous thromboembolism (VTE), a 1.2-fold increased risk of atherosclerotic cardiovascular disease  (ASCVD), and a 2-fold increased risk of heart failure (HF), according to a literature review study published in Therapeutic Advances in Gastroenterology. 

The researchers uncovered the data related to the link between IBD and VTE in two meta-analyses of case-control studies, prospective cohort studies and population-based control studies.

Specifically, most VTE cases (around 90%) concern deep venous thrombosis [DVT; relative risk (RR)=2.42; 95% confidence interval (95% CI), 1.78–3.30] or pulmonary embolism (PE; RR=2.53; 95% CI, 1.95–3.28). In the remaining 10% of VTE cases, they noted, other locations are affected, such as the mesenteric and cerebral veins. Analysis shows that the risk recurrent VTE within five years after discontinuation of coagulation therapy is higher among IBD patients compared to the general population (33.4% versus 21.7%, respectively; p = 0.010). 

“Noteworthy, half of IBD patients had active disease at time of recurrent VTE. These data indicate that thromboprophylaxis may be considered during flares in IBD patients with a history of VTE,” the researchers wrote.

Regarding risk factors for ASCVD in IBD, the relative risk of cerebrovascular disease (CeVD) is more pronounced in women, and patients below the age of 40.  A potential explanation, the researchers postulated, might be the greater contribution of chronic inflammation in the pathogenesis of ASCVD in women as compared with men.

“The increased ASCVD risk in IBD patients is not fully explained by an increased prevalence of traditional risk factors, according to available data. A large population study showed no increase in the traditional cardiovascular risk factors in IBD patients as compared with the general population,” the researchers wrote.

Pertaining to HF, the researchers cited a large Danish population study that demonstrated that IBD patients with disease flares and persistent disease activity are 2.5 times more like to be admitted to the hospital due to HF as compared with IBD patients in remission. They noted that risk factors associated with HF were extent of inflammation (colonic disease in CD, pancolitis in UC), female sex, and age exceeding 40 years

“The increased risk of CVD concerns an increased risk of venous thromboembolism (VTE), atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), at corresponding relative risks of 2.5, 1.2 and 2.0, respectively, as compared with the general population. Especially young patients under the age of 40 years run a relatively high risk of these complications when compared with the general population. Chronic systemic inflammation causes a hypercoagulable state leading to the prothrombotic tendency characteristic of VTE, and accelerates all stages involved during atherogenesis in ASCVD,” the researchers concluded.

They added that “[increased] awareness of VTE risk is warranted in patients with extensive colonic disease in both ulcerative colitis and Crohn’s disease, as well as during hospitalization, especially when patients are scheduled for surgery.”