title: Inflammatory bowel disease as a risk factor for premature coronary artery disease.
abstract: BACKGROUND
  Crohn's disease and ulcerative colitis are both systemic chronic diseases that alter bowel physiology. The central process in inflammatory bowel disease (IBD) and the associated manifestations are the result of B-cell production of IgG autoantibodies directed against self-antigens in various organ systems including coronary endothelium. Previous studies have demonstrated significant micro-vascular endothelial dysfunction in patients with IBD compared to patients not affected by the disease. We sought to analyze the relation, if any, between IBD and the development of premature coronary artery disease (CAD).
  
  
  METHODS
  We queried our hospital database to find IBD patients admitted to the hospital from January 1, 2007 to December 31, 2008. Patients with traditional cardiovascular (CV) disease risk factors including hypertension, congestive heart failure (CHF), diabetes, age ≥ 65, hyperlipidemia, family history, end-stage renal disease (ESRD), and greater than five pack-year smoking history were excluded from the study cohort. The charts of the remaining 300 patients with diagnosed IBD were then analyzed for the incidence of CV disease events including acute myocardial infarction (MI), unstable angina, positive stress testing, and any cardiac intervention including coronary angioplasty and/or intracoronary stent implantation.
  
  
  RESULTS
  Of the 300 patients included, only one patient had a CV disease event. This patient had a positive exercise stress thallium test. Otherwise, the remaining 299 patients (99.7%) did not have any reported CV disease events over the 2-year follow-up period.
  
  
  CONCLUSIONS
  Most of the clinical sequelae of CV disease events are the result of inflammatory changes at the vascular level. While IBD is associated with a chronic inflammatory state as reflected by high sedimentation rates, C-reactive protein (CRP), homocysteine levels, etc., our data seem to indicate that chronic inflammation in the absence of traditional risk factors is not associated with an increased risk of premature CV disease events. More wide-scale prospective studies should be performed to elucidate the relationship, if any, between chronic inflammation and CV disease risk.
authors.affiliation: Rhode Island Hospital/Brown University School of Medicine, Providence, RI 02903, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruisi
authors.affiliation: North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Makaryus
authors.affiliation: Mount Sinai Beth Israel, New York, NY 10003, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ruisi
authors.affiliation: North Shore-Long Island Jewish Health System, Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA.
authors.forename: Amgad N
authors.initials: AN
authors.lastname: Makaryus
keywords: Coronary artery disease; Crohn’s disease; Inflammatory bowel disease; Ulcerative colitis