Introduction

Inflammatory bowel disease is a condition which causes inflammation in the gastrointestinal tract, due to an abnormal immune response.¹ There are two main types of inflammatory bowel disease, which are Crohn's disease and ulcerative colitis. Cardiovascular diseases are diseases which affect the cardiovascular system. Cardiovascular diseases have an increased level of mortality rate. This article will discuss and explore the link between inflammatory bowel disease and cardiovascular diseases. 

Understanding inflammatory bowel disease (IBD)

Inflammation happens in the body as a result of harmful foreign matter entering the body, e.g. bacteria and viruses. Inflammation acts as a defence mechanism, where it would eliminate the foreign stimuli from our body.²

However, inflammation can also lead to harmful diseases. This occurs when the immune system targets its own cells.³ This occurs in inflammatory bowel disease. There are two main types of inflammatory bowel disease, and these are Crohn’s disease and ulcerative colitis. 

Crohn's disease occurs when there is inflammation of parts of the digestive system.⁴ Ulcerative colitis is where the colon and the rectum are become inflamed.⁵ Both conditions are long-term diseases. 

Symptoms 

Symptoms of Crohn’s disease include:

• Tiredness 
• Blood in the poo 
• Weight loss 
• Diarrhoea 
• Stomach aches and cramps⁴

Symptoms of ulcerative colitis include: 

• Stomach pain 
• Recurring diarrhoea with blood, pus or mucus 
• Frequent urination 
• Tiredness 
• Weight loss 
• Loss of appetite⁵

Diagnosis 

The typical pathway to diagnose Crohn’s disease includes:

• Initial checks 
  • Stomach examination 
  • Blood sample 
  • Stool sample
• Further checks
  • Colonoscopy 
  • Biopsy
  • MRI or CT scan⁶

Diagnosis of ulcerative colitis includes:

• Initial checks
  • Blood sample 
  • Stool sample 
• Further checks
  • X-ray or CT scan 
  • Sigmoidoscopy - a thin tube with camera insert into the rectum and a small tissue sample can be taken for biopsy
  • Colonoscopy - a camera is inserted to view the whole colon and a sample tissue can be taken⁷

Impact of IBD on quality of life

IBD can have a significant impact on the quality of life for patients, but it can be controlled by maintaining a healthy lifestyle and following a special diet. A major factor in avoiding flare-ups of Crohn’s disease is to prioritise low-fibre and easy to digest foods.¹⁷ Complications of the disease include osteoporosis, anaemia and bowel cancer.⁸

Similar to Crohn’s disease, ulcerative colitis would be controlled by maintaining a special diet. Ways to control this include eating smaller meals, a low-fibre diet and taking food supplements.⁹ Stress can also worsen flare-ups of ulcerative colitis and so good management of stress levels can reduce symptom frequency.⁹

Understanding cardiovascular diseases (CVD)

Cardiovascular diseases affect the cardiovascular system, which consists of blood vessels and the heart. The heart is an important organ/muscle which controls the blood flow in our body, by pumping the oxygenated blood around the body and getting deoxygenated blood from the heart to the lungs. The oxygenated blood carries nutrients to the cells. This is where the blood vessels take part by carrying the blood around the body. The most common cardiovascular diseases are stroke and heart disease, as a result of fat build up in the blood vessels, connected to either the heart or brain.

Risk factors

The risk factors that can cause cardiovascular diseases include:

• High blood pressure 
• High cholesterol
• Diabetes 
• Being overweight 
• Smoking 
• Consuming alcohol¹⁰

Impact of CVD on health and mortality

Cardiovascular disease has an enormous impact on health, because it can lead to life threatening conditions, such as heart attacks. According to WHO, heart disease is the leading cause for high mortality rates worldwide from 2000 to 2019.¹¹

Linking inflammatory bowel disease and cardiovascular diseases

IBD does have a link with cardiovascular disease, with chronic inflammation being the key factor. IBD causes an increased risk of atherosclerosis and higher levels of coagulation factors to be released, and this contributes to thromboembolic events.¹² Thromboembolic event is a condition where blood clots are formed in the veins.¹⁴ Moreover, the microbiota alterations can lead to atherosclerosis formation.¹² Both IBD and CVD have some similar risk factors, including smoking and diet.¹⁵ 

Management and prevention strategies

To treat IBD, corticosteroid is usually taken, but this can increase the risk of CVD.¹⁶ There are certain treatments involved to prevent IBD patients developing CVD. To treat these diseases, medication that are used include:

• Aspirin - will reduce the chances of CVD, colorectal adenoma and cancer.¹⁶ Low-dose aspirin is preferably used
• Heparin - has anti-inflammatory and anticoagulant properties 
• Statins - has anti-inflammatory effect

Another way of minimising the risk is to consider what triggers flare-ups and follow a healthy lifestyle. Small, regular meals canhelp to suppress the symptoms. 

Summary 

CVD is the main reason for the high mortality rate worldwide. IBD is inflammation of the bowel and there are two types, which are Crohn's disease and ulcerative colitis. IBD is linked to cardiovascular disease, because of the chronic inflammation it causes. Inflammation can lead to atherosclerosis, which in turn can lead to cardiovascular diseases, such as heart attack and stroke. 

There are treatments available to prevent the development of CVD, but it is important to consider the risk factors to minimise the risk. It is important to understand the link between IBD and CVD, to lower the mortality rate.