Risk of heart attacks linked to certain ulcerative colitis medications
Ulcerative colitis (UC), a type of chronic inflammatory bowel disease (IBD), can increase a person's risk of cardiovascular disease. This increased risk is due to the inflammation in the body, which can lead to narrowed arteries, plaque buildup, and the formation of blood clots.
In the quest to manage this risk, several treatment options for UC have been explored. Among them, anti-TNF agents stand out for their potential to reduce cardiovascular risk. Studies suggest that these biologics, which work by reducing systemic inflammation, are the most effective advanced therapies in lowering risks of myocardial infarction (MI), ischemic heart disease (IHD), cerebrovascular accidents (CVA), and major adverse cardiovascular events (MACE) compared to no treatment or placebo.
However, the cardiovascular safety profiles of other treatments are less clear. For instance, while Vedolizumab and Ustekinumab have shown promise, direct comparative CV event data are limited. Ustekinumab may be safer than anti-TNF agents in terms of short-term adverse events, but its CV benefits are not as well defined. More robust head-to-head CV safety data are needed for definitive conclusions.
Tofacitinib, a JAK inhibitor, is effective for UC but requires caution due to concerns about increased cardiovascular risks, particularly with lipid elevations and thrombotic events. As such, cardiovascular risk factors should be monitored and managed actively when using JAK inhibitors.
Corticosteroids, often used to treat UC, are linked to an increased CV risk due to their side effects such as hypertension, dyslipidemia, and weight gain. Prolonged use of corticosteroids may raise the risk of cardiovascular disease in people with chronic inflammatory conditions.
Current guidelines from the American College of Cardiology and the American Heart Association do not specifically address UC, but they do note that chronic inflammatory conditions increase cardiovascular risk. Treatment with medications like statins, which reduce the risk of heart attack and stroke, may help limit the frequency of flares and decrease the symptoms of UC.
In addition to medication, 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.
More research is necessary to learn how factors such as UC disease duration and activity affect the risk of cardiovascular disease. Some research suggests the risk of a cardiovascular event in people with IBD is higher during an active flare of the condition.
People with UC often limit high fiber foods during a flare to ease cramps and diarrhea, but dietary fiber can have health benefits for people with IBD. Having IBD may also increase a person's risk of atherosclerosis, which is the buildup of plaque in the arteries and raises the risk of heart attack and stroke.
The American Gastroenterological Association recommends certain treatments for the long-term management of moderate to severe UC, including antitumor necrosis factor (TNF) agents, vedolizumab, ustekinumab, tofacitinib, and integrin inhibitors. Some research suggests anti-TNF medications might decrease cardiovascular risk in people with IBD.
In conclusion, while more research is needed, anti-TNF agents currently demonstrate the best evidence for lowering CV risk in UC compared with placebo or other treatments. Ustekinumab may be safer in terms of short-term adverse events but with less clear CV benefits. JAK inhibitors and corticosteroids can increase CV risk, necessitating careful patient selection and monitoring. People with UC should discuss their cardiovascular risk with their doctor and follow recommended treatments and lifestyle changes to manage their risk.
- Ulcerative colitis (UC) can increase a person's risk of cardiovascular disease, such as myocardial infarction (MI) and cerebrovascular accidents (CVA), due to inflammation in the body leading to narrowed arteries, plaque buildup, and blood clots.
- Anti-TNF agents, which reduce systemic inflammation, have been found to be the most effective advanced therapies in lowering the risks of cardiovascular conditions in UC patients compared to no treatment or placebo.
- Although Ustekinumab may be safer than anti-TNF agents in terms of short-term adverse events, its cardiovascular benefits are not as well defined, and more robust head-to-head CV safety data are needed for definitive conclusions.
- Corticosteroids, often used to treat UC, are linked to an increased cardiovascular risk due to side effects like hypertension, dyslipidemia, and weight gain. Prolonged use of corticosteroids may raise the risk of cardiovascular disease in people with chronic inflammatory conditions.
