Exam 2: Increased Risk of Acute Myocardial Infarction and Heart Failure in Patients With Inflammatory Bowel Diseases

Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.

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Increased risk of morbidity associated with immunomodulatory treatment in patients with inflammatory bowel diseases

Immunoregulation in Inflammatory Bowel Diseases — Current Understanding and Innovation - Falk Symposium ◽

10.1007/978-1-4020-5889-9_10 ◽

2007 ◽

pp. 85-98

Author(s):

J. -F. Colombel ◽

M. Toruner

Keyword(s):

Inflammatory Bowel Diseases ◽

Immunomodulatory Treatment ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel

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Optimization of antenatal monitoring approaches of women with chronic inflammatory bowel diseases

Reproductive Endocrinology ◽

10.18370/2309-4117.2021.57.84-92 ◽

2021 ◽

pp. 84-92

Author(s):

O.V. Bulavenko Bulavenko ◽

D.G. Konkov ◽

N.V. Kuzminova ◽

T.V. Lobastova ◽

I.V. Oleksienko

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Inflammatory Bowel Diseases ◽

Clinical Guidelines ◽

Cochrane Library ◽

Chronic Inflammatory Bowel Diseases ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Chronic Inflammatory Bowel

Chronic inflammatory bowel diseases (CIBD) affect patients at their peak of reproductive age. Clinical presentation of CIBD in pregnancy is associated with an increased risk of adverse effects in mother and fetus, including prematurity, low birth weight, increased indications for caesarean section. Thus optimizing of the CIBD diagnosis and treatment before and during pregnancy is essential to improve maternal and fetal outcomes.Research aim: to analyze the effectiveness of the CIBD clinical management at the stage of preconception and during pregnancy.Materials and methods. It was searched the Cochrane Library, WHO platform, clinical guidelines, and research reference database Medline. All potential studies have evaluated the clinical practice guidelines in women with CIBD for conception, pregnancy and breastfeeding. Recommendations related to the necessary laboratory and instrumental examination methods, therapeutic strategy, the safety of drugs for mother and fetus, the features of multidisciplinary antenatal observation, the timing and method of delivery of pregnant women with CIBD. Results. Treatment in the planning phase and pregnancy should be multidisciplinary, involving a gastroenterologist, obstetrician-gynecologist, primary care physician, pediatrician and a colorectal surgeon if necessary, as well as stakeholders from the association of patients with CIBD. Communication between these professionals is critical to avoid ambivalent or even conflicting counseling, which is an additional source of anxiety for patients, and also potentially dangerous for suboptimal prevention of clinical CIBD manifestation. Obtained results of the analysis will prevent laboratory and therapeutic polypharmacy and significantly improve the pregnancy outcome.Conclusions. Most women with CIBD had a physiological pregnancy and healthy children. However, some studies have linked CIBD to an increased risk of preterm birth and low birth weight infants. The development of national clinical guidelines will optimize and improve the quality of perinatal care to women with CIBD in the Ukraine, and will lead to a decrease in obstetric, fetal and neonatal complications.

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Risk, Course, and Effect of SARS-CoV-2 Infection in Children and Adults with Chronic Inflammatory Bowel Diseases

Children ◽

10.3390/children8090753 ◽

2021 ◽

Vol 8 (9) ◽

pp. 753

Author(s):

Angelica Corrias ◽

Gian Mario Cortes ◽

Flaminia Bardanzellu ◽

Alice Melis ◽

Vassilios Fanos ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Bacterial Infections ◽

Immunosuppressive Treatment ◽

Epidemiological Data ◽

Adverse Outcomes ◽

Biologic Drugs ◽

Angiotensin Converting Enzyme 2 ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel

Susceptibility and disease course of COVID-19 among patients with inflammatory bowel diseases (IBD) are unclear and epidemiological data on the topic are still limited. There is some concern that patients with immuno-mediated diseases such as IBD, which are frequently treated with immunosuppressive therapies, may have an increased risk of SARS-CoV-2 infection with its related serious adverse outcomes, including intensive care unit (ICU) admission and death. Corticosteroids, immunomodulators, and biologic drugs, which are commonly prescribed to these patients, have been associated with higher rates of severe viral and bacterial infections including influenza and pneumonia. It is not known whether these drugs can be so harmful as to justify their interruption during COVID-19 infection or if, on the contrary, patients with IBD can benefit from them. As shown by recent reports, it cannot be excluded that drugs that suppress the immune system can block the characteristic cytokine storm of severe forms of COVID-19 and consequently reduce mortality. Another cause for concern is the up-regulation of angiotensin converting enzyme-2 (ACE2) receptors that has been noticed in these patients, which could facilitate the entry and replication of SARS-CoV-2. The aim of this narrative review is to clarify the susceptibility of SARS-CoV-2 infection in patients with IBD, the clinical characteristics of patients who contract the infection, and the relationship between the severity of COVID-19 and immunosuppressive treatment.

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D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

Heart ◽

10.1136/heartjnl-2020-316880 ◽

2020 ◽

pp. heartjnl-2020-316880 ◽

Cited By ~ 1

Author(s):

Xiaoyuan Zhang ◽

Shanjie Wang ◽

Jinxin Liu ◽

Yini Wang ◽

Hengxuan Cai ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Plaque Rupture ◽

Risk Of Death ◽

Increased Risk ◽

Clinical Covariates ◽

All Cause Mortality ◽

D Dimer

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.MethodsWe enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.ResultsOver a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.ConclusionsD-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

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Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases

Nutrients ◽

10.3390/nu12061702 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1702

Author(s):

Alicja Ewa Ratajczak ◽

Anna Maria Rychter ◽

Agnieszka Zawada ◽

Agnieszka Dobrowolska ◽

Iwona Krela-Kaźmierczak

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Inflammatory Bowel Diseases ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Increased Risk ◽

Bowel Diseases ◽

Calcium Phosphorus ◽

Prevention Of Osteoporosis ◽

Inflammatory Bowel

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.

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Increased Risk of Oral Cancer in Patients With Inflammatory Bowel Diseases

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2015.09.041 ◽

2016 ◽

Vol 14 (3) ◽

pp. 413-420 ◽

Cited By ~ 9

Author(s):

Konstantinos H. Katsanos ◽

Giulia Roda ◽

Russell B. McBride ◽

Benjamin Cohen ◽

Jean-Frédéric Colombel

Keyword(s):

Oral Cancer ◽

Inflammatory Bowel Diseases ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel

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Does sacubitril/valsartan work in acute myocardial infarction? The PARADISE-AMI study

European Heart Journal Supplements ◽

10.1093/eurheartj/suab098 ◽

2021 ◽

Vol 23 (Supplement_E) ◽

pp. E87-E90

Author(s):

Laura Gatto

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Left Ventricular Dysfunction ◽

Clinical Studies ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Laboratory Animals ◽

Risk Of Death ◽

Increased Risk

Abstract Patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction have an increased risk of death and heart failure. Numerous clinical studies have demonstrated the ability of ACE inhibitors in optimizing the outcome in this particular clinical setting. In recent years, the sacubitril/valsartan association has drastically improved the prognosis of patients with heart failure with reduced ejection fraction with a significant decrease in mortality from cardiovascular causes and hospitalizations due to acute heart failure. However, it has not yet been fully clarified whether this pharmacological association may play a role in patients with AMI. Pre-clinical studies have suggested the possibility that sacubitril/valsartan can reduce the size of the infarct scar and prevent the onset of ventricular arrhythmias in laboratory animals in which myocardial infarction was induced. On the other hand, small clinical experiences with patients after myocardial infarction have provided conflicting data. The results of the PARADISE-MI study were recently presented, which enrolled 5661 patients with AMI complicated by pulmonary congestion and left ventricular dysfunction randomized to therapy with ramipril or sacubitril/valsartan and followed up for ∼2 years. Although combination therapy was associated with an ∼10% reduction in the risk of death from cardiovascular causes or an episode of heart failure, this was not enough to achieve statistical significance. However, treatment with sacubitril/valsartan was shown to be more effective than ramipril in preventing recurrence of heart failure after the first one.

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Vedolizumab: Potential Mechanisms of Action for Reducing Pathological Inflammation in Inflammatory Bowel Diseases

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.612830 ◽

2021 ◽

Vol 9 ◽

Author(s):

Matthew Luzentales-Simpson ◽

Yvonne C. F. Pang ◽

Ada Zhang ◽

James A. Sousa ◽

Laura M. Sly

Keyword(s):

T Cells ◽

T Cell ◽

Inflammatory Bowel Diseases ◽

Necrosis Factor Alpha ◽

Cell Recruitment ◽

Inflammatory Monocytes ◽

Increased Risk ◽

Bowel Diseases ◽

Cytokine Tumor Necrosis Factor ◽

Inflammatory Bowel

Inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC), and Crohn’s disease (CD), are a group of disorders characterized by chronic, relapsing, and remitting, or progressive inflammation along the gastrointestinal tract. IBD is accompanied by massive infiltration of circulating leukocytes into the intestinal mucosa. Leukocytes such as neutrophils, monocytes, and T-cells are recruited to the affected site, exacerbating inflammation and causing tissue damage. Current treatments used to block inflammation in IBD include aminosalicylates, corticosteroids, immunosuppressants, and biologics. The first successful biologic, which revolutionized IBD treatment, targeted the pro-inflammatory cytokine, tumor necrosis factor alpha (TNFα). Infliximab, adalimumab, and other anti-TNF antibodies neutralize TNFα, preventing interactions with its receptors and reducing the inflammatory response. However, up to 40% of people with IBD become unresponsive to anti-TNFα therapy. Thus, more recent biologics have been designed to block leukocyte trafficking to the inflamed intestine by targeting integrins and adhesins. For example, natalizumab targets the α4 chain of integrin heterodimers, α4β1 and α4β7, on leukocytes. However, binding of α4β1 is associated with increased risk for developing progressive multifocal leukoencephalopathy, an often-fatal disease, and thus, it is not used to treat IBD. To target leukocyte infiltration without this life-threatening complication, vedolizumab was developed. Vedolizumab specifically targets the α4β7 integrin and was approved to treat IBD based on the presumption that it would block T-cell recruitment to the intestine. Though vedolizumab is an effective treatment for IBD, some studies suggest that it may not block T-cell recruitment to the intestine and its mechanism(s) of action remain unclear. Vedolizumab may reduce inflammation by blocking recruitment of T-cells, or pro-inflammatory monocytes and dendritic cells to the intestine, and/or vedolizumab may lead to changes in the programming of innate and acquired immune cells dampening down inflammation.

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