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.
UC and Crohn’s disease are types of chronic inflammatory bowel disease (IBD). Having IBD may increase a person’s risk of cardiovascular disease, such as heart attack and stroke.
Read on to learn more about the potential links between UC and cardiovascular disease.
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.
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), an integrin inhibitor
ustekinumab (Stelara), an interleukin 12/23 inhibitor
tofacitinib (Xeljanz), a Janus kinase inhibitor
Treatment with one of these medications may help limit the frequency of flares and decrease the symptoms of UC.
These medications also decrease the inflammation some experts believe is involved in cardiovascular disease.
Some research suggests anti-TNF medications might decrease cardiovascular risk in people with IBD. A 2018 national database study 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 in those with UC.
Doctors may also prescribe short-term treatment with corticosteroids during a UC flare to help bring the condition into remission.
However, prolonged use of corticosteroids may actually raise the risk of cardiovascular disease in people with chronic inflammatory conditions.
Why is UC associated with increased cardiovascular risk?
More research is necessary to learn why people with UC have increased cardiovascular risk. Experts believe chronic inflammation plays an important role.
According to a 2018 review of studies, 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 have an increased risk of atherosclerosis. Atherosclerosis refers to the buildup of plaque in the arteries. It raises the risk of heart attack and stroke.
Review authors 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, such as from IBD, affects the lining of blood vessels, it may contributeTrusted Source to narrowed arteries and plaque buildup.
In addition, inflammation also promotes the formation of blood clots. A blood clot may block an artery in the:
lungs, causing a pulmonary embolism
heart, causing a heart attack
brain, causing a 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
A 2020 review also concludes that people with IBD have a two- to threefold higher risk of venous thromboembolism (VTE) than the larger 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.
More research about the relationship between UC and increased risks of cardiovascular disease is needed.
Does UC increase the risk more in some people than in others?
Some research suggests the risk of a cardiovascular event in people with IBD is higher during an active flare of the condition.
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: A 2018 French cohort study identified the highest risk in people under 55 years old.
Assessing cardiovascular risk
Doctors typically assess the chances of a cardiovascular event 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 the American Heart Association do not specifically address UC. However, they do note that chronic inflammatory conditions increase cardiovascular risk.
It is best for a person to contact their doctor for advice if they have concerns about their 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.
Doctors may also recommend one or more of the following to manage cardiovascular risk factors:
medications to lower blood sugar, blood cholesterol, or blood pressure
dietary changes, including eating a variety of fiber-rich foods, such as whole grains, legumes, vegetables, fruits, and nuts
changes to exercise routines or the amount of physical activity a person gets
counseling or support to help the person quit smoking, if applicable
People with UC often limit high fiber foods during a flare to ease cramps and diarrhea. However, dietary fiber can have significantTrusted Source health benefits for people with IBD.
A person’s doctor can advise on how much fiber they should aim to consume. Taking medication to control inflammation and symptoms may allow people with UC to eat more varied diets and stay active, which can help reduce cardiovascular risk.
Summary
People with ulcerative colitis (UC) and other types of irritable bowel disease (IBD) might 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 people experiencing an active flare of IBD.
Chronic inflammation may partly account for this increased risk. Some evidence suggests prolonged corticosteroid use may also contribute.
A person’s doctor can help identify and manage cardiovascular risk factors. They may recommend medications, lifestyle changes, or other treatments.
Last medically reviewed on January 24, 2024
Heart DiseaseUlcerative Colitis
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