Cardiovascular risk stratification in patients with inflammatory bowel disease: The role of non-invasive imaging techniques and traditional risk scores

Abstract

Background: Patients with chronic inflammatory diseases, including inflammatory bowel diseases (IBD), have a 20% increased risk for atherosclerotic cardiovascular disease (ASCVD) and death as compared to non-inflamed subjects. A more in-depth screening of patients has become important with the EMA warning for JAK-inhibitors. The current validated cardiovascular risk (CVR) stratification algorithms are based on traditional risk factors, not taking into account the contribution of chronic inflammation.
Aim of the study: Our study aimed to stratify the CV risk of IBD patients using validated scores (SCORE2/SCORE2-OP/SCORE- 2Diabetes) and performing carotid ultrasonography to identify subclinical atherosclerosis.
Materials and methods: Data from 120 consecutive IBD patients [Ulcerative Colitis(UC): 67; Crohn’s disease(CD):53] aged ≥40 years under care in the IBD Unit of the University Hospital of Messina (April-to-July 2024) were collected. We recorded data on age, gender, region of origin, body mass index, smoking history, family, personal and pharmacological history, blood pressure values, biochemistry (creatinine, fasting glucose, glycated hemoglobin, total cholesterol, HDL-cholesterol, triglycerides). LDL-C/non-HDL-C were thus calculated. Additional IBD-related parameters potentially associated with an increased CVR were investigated (i.e., disease activity, current therapies, duration of disease, and extraintestinal manifestations).
Results: Based on their medical history, 48% of patients were classified as at intermediate CVR, 34% as high CVR, and 18% as very high CVR. Carotid ultrasound detected subclinical atherosclerosis in 48.3% of patients. CV risk reclassification occurred in 21%, increasing the proportion of patients with high/very-high risk from 50% to 71%. Active disease (p=0.047) and concomitant spondyloarthropathies (p=0.03) were identified as additional risk factors.
Conclusions: Our findings demonstrate that carotid ultrasonography significantly reclassifies CV risk, revealing that traditional risk scores underestimate CV risk in IBD patients. Tailored CV risk stratification, incorporating chronic inflammation, is crucial before initiating therapies like JAK-inhibitors to minimize side effects, including CV complications. Active intestinal disease and spondyloarthritis further exacerbate CV risk, underscoring the need for integrated screening and management strategies in this population.