Inflammation has long been associated with the development of cardiovascular disease (CVD). Several rheumatologic conditions are linked to CDV, but such a relationship has not been well established in Inflammatory Bowel Disease (IBD). IBD comprises Ulcerative Colitis and Crohn’s Disease, both of them causing chronic intestinal inflammation. Several studies have proposed a link between IBD and an increased risk of atherosclerotic cardiovascular disease (ASCVD) and it is interesting to investigate in-depth this association to understand how IBD and its treatments affect ASCVD risk factors and discuss a clinical approach to preventing ASCVD. Literature data have found inflammatory markers for IBD: C-reactive protein, tumor necrosis factor-alpha, immunoglobulins IgG and IgM, vascular endothelial growth factor, and interleukin-1. It has been demonstrated that the activation of these cytokines causes endothelial dysfunction and macrophage accumulation, which leads to atherosclerotic plaque formation. Notably, several studies have shown that patients with a high concentration of high-sensitive C-reactive protein have an elevated risk of ASCVD.

The prevalence of ASCVD risk factors such as smoking, diabetes, hypertension, and hyperlipidemia correlates with a higher risk of cardiovascular events, and plays a role in IBD patients as well:

• Smoking. 29% of IBD patients are active smokers and smoking is know to aggrevate Crohn’s. It has been demonstrated that cigarette smoking causes endothelial dysfunction, leading to atherosclerosis.
• Diabetes. Incidental diabetes occurs more frequently in IBD patients and, in particular, in Crohn’s Disease patients, increasing the risk of ASCVD.
• Hyperlipidemia. Literature data showed that IBD patients had a significantly lower level of lipids compared to non-IBD patients. However, some IBD patients had an increased carotid thickness and high-sensitive C-reactive protein concentration.
• Hypertension. Several studies demonstrated that IBD patients, despite a low rate of hypertension, had an increase in acute coronary syndrome.
• Body mass index. Patients with obesity had a two-fold risk to develop IBD, in particular Crohn’s Disease, probably due to altered gut adsorption in obese patients.
• Diet. Guidelines suggest diet recommendations to prevent ASCVD risk factors (i.e. diabetes, obesity) and a specific diet should be recommended in IBD patients.
• Sex. Women with IBD have a higher risk to develop ASCVD compared to men, and this is probably due to their higher baseline level of high-sensitive C-reactive protein. Moreover, 88% of IBD women are hormonal contraceptive users, leading to an increased risk of thromboembolic diseases.
• Medications for IBD. Steroid, used for the IBD treatment, had been associated with an increase of ASCVD risk factors (i.e. hyperlipidemia, hyperglycemia, and hypertension).

Studies have shown that in patients with IBD the likelihood of heart failure is twice as high as in other patients taking steroids, with the risk being higher among IBD patients taking steroids, as well as the incidence of atrial fibrillation risk is significant in IBD patients compared with non-IBD patients (11.3% and 0.9%, respectively). Based on the data presented, physicians should assess the risk of developing ASCVD in IBD patients, particularly in individuals < 50 years of age and women with IBD. Further studies will be needed to investigate the association between IBD, ASCD, atrial fibrillation, and heart failure.