5.5 ARTERIAL STIFFNESS IS INCREASED IN INFLAMMATORY BOWEL DISEASE, DEPENDENT UPON INFLAMMATION AND REDUCED BY IMMUNOMODULATORY DRUGS

Abstract

Background. Inflammatory bowel disease (IBD) is associated with an increased cardiovascular risk that is not explained by traditional cardiovascular risk factors, as well as an increased arterial stiffness. In this study, we investigated the relationship between inflammation and arterial stiffening and tested the hypothesis that aortic stiffening is reduced by immunomodulatory therapy in IBD. Methods. Pulse wave velocity (PWV) was measured in 80 IBD patients and 80 matched controls. Both acute and chronic inflammatory measures were determined. The effect of therapy on PWV was measured at 0 and 3.3 ± 0.3 years in 13 IBD patients treated with immunomodulating drugs (steroids, anti TNF-α or azathioprine) and in 10 IBD patients treated only with salicylates. Results. IBD patients, compared with controls, have higher carotid-femoral PWV (7.9 ± 1.6 vs. 7.0 ± 1.1 m/s, respectively; P < 0.001) and carotid-radial PWV (8.8 ± 1.3 vs. 7.2 ± 0.9 m/s, respectively; P < 0.001). Age was a determinant of carotid-femoral PWV in both groups and of carotid-radial PWV in IBD patients. In fully adjusted models performed on IBD subjects, carotid-femoral PWV was positively associated with disease duration, and carotid-radial PWV was positively associated with a history of IBD reactivation and high-sensitivity C-reactive protein. For a comparable value at baseline, the variation of carotid-femoral PWV during follow-up was significantly reduced in subjects treated with immunomodulating drugs compared with those treated only with salicylates (+0.03 ± 0.22 vs. +0.23 ± 0.19 m/s/year of follow-up, respectively; P < 0.05; Fig. 1). Conclusions. IBD is associated with increased arterial stiffness, which correlates with markers of chronic and acute inflammation. Aortic stiffening is reduced by immunomodulating drugs.