Intest Res.  2014 Oct;12(4):293-298. 10.5217/ir.2014.12.4.293.

Does Carotid Intima-Media Thickness Increase in Patients With Inflammatory Bowel Disease?

• Kim KO
• Jang BI
• Lee SH

• KMID: 2174406
• DOI: http://doi.org/10.5217/ir.2014.12.4.293

Abstract

BACKGROUND/AIMS
Mesenteric microvascular thrombosis has been implicated as a contributing factor to the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to assess the possibility of subclinical atherosclerosis in patients with IBD by measuring their carotid intima-media thickness (c-IMT).
METHODS
Thirty-eight patients with IBD who were followed-up for at least 3 years participated. Patients with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded. As a control group, 38 healthy patients matched for age and gender without atherosclerosis risk factors were included. Carotid ultrasonography was performed in all patients and controls. Patient baseline characteristics and laboratory parameters were recorded to evaluate atherosclerosis risk factors.
RESULTS
The mean age of patients with IBD was 38.5+/-6.62 years. Twenty-three patients with IBD were diagnosed with ulcerative colitis and the other 15 cases were diagnosed with Crohn's disease. The median duration of disease was 52.0 months. Serologic markers such as erythrocyte sedimentation rate, C-reactive protein (CRP), and cholesterol levels differed significantly, however, there was no significant difference in c-IMT between patients with IBD and those in the control group (0.53+/-0.10 mm vs. 0.53+/-0.07; P=0.85). Multivariate analysis revealed that body mass index, CRP, disease duration, and age were significantly correlated with c-IMT in patients with IBD.
CONCLUSIONS
The results of the current study did not show an increase in c-IMT in patients with IBD. Further studies that include more subjects and a longer follow-up period will be necessary in order to evaluate the risk of atherosclerosis in Korean patients with IBD.

Keyword

Atherosclerosis; Carotid intima-media thickness; Inflammatory bowel diseases

MeSH Terms

Atherosclerosis
Blood Sedimentation
Body Mass Index
C-Reactive Protein
Cardiovascular Diseases
Carotid Intima-Media Thickness*
Cholesterol
Colitis, Ulcerative
Crohn Disease
Follow-Up Studies
Humans
Inflammatory Bowel Diseases*
Multivariate Analysis
Risk Factors
Thrombosis
Ultrasonography
C-Reactive Protein
Cholesterol

Figure

• 

  Fig. 1 Carotid intima-media thickness (c-IMT) ultrasonography measurement. c-IMT was measured on the far wall at 5, 10, and 15 mm proximal to the carotid bifurcation over both carotid arteries. ECA, external carotid artery; ICA, internal carotid artery; CCA, common carotid artery.

Reference

1. Karlinger K, Gyorke T, Mako E, Mester A, Tarjan Z. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol. 2000; 35:154–167. PMID: 11000558.

2. Hisamatsu T, Mikami Y, Matsuoka K, Kanai T, Hibi T. Immunological abnormalities in the pathogenesis of inflammatory bowel disease. Intest Res. 2012; 10:317–323.

3. Nagahori M, Nemoto Y, Watanabe M. Pathogenesis of inflammatory bowel diseases. Intest Res. 2010; 8:9–17.

4. Roman MJ, Shanker BA, Davis A, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003; 349:2399–2406. PMID: 14681505.

5. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum. 2002; 46:862–873. PMID: 11953961.

6. Willinek WA, Ludwig M, Lennarz M, Holler T, Stumpe KO. High-normal serum homocysteine concentrations are associated with an increased risk of early atherosclerotic carotid artery wall lesions in healthy subjects. J Hypertens. 2000; 18:425–430. PMID: 10779093.

7. Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens. 2002; 20:159–169. PMID: 11821696.

8. Aminbakhsh A, Mancini GB. Carotid intima-media thickness measurements: what defines an abnormality? A systematic review. Clin Invest Med. 1999; 22:149–157. PMID: 10497713.

9. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Cardiovascular Health Study Collaborative Research Group. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med. 1999; 340:14–22. PMID: 9878640.

10. Dagli N, Poyrazoglu OK, Dagli AF, et al. Is inflammatory bowel disease a risk factor for early atherosclerosis? Angiology. 2010; 61:198–204. PMID: 19398421.

11. Papa A, Santoliquido A, Danese S, et al. Increased carotid intima-media thickness in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2005; 22:839–846. PMID: 16225493.

12. Maharshak N, Arbel Y, Bornstein NM, et al. Inflammatory bowel disease is not associated with increased intimal media thickening. Am J Gastroenterol. 2007; 102:1050–1055. PMID: 17313498.

13. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1:307–310. PMID: 2868172.

14. Paoletti R, Gotto AM Jr, Hajjar DP. Inflammation in atherosclerosis and implications for therapy. Circulation. 2004; 109:III20–III26. PMID: 15198962.

15. Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how "high-grade" systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003; 108:2957–2963. PMID: 14676136.

16. Del Rincon I, Williams K, Stern MP, Freeman GL, O'Leary DH, Escalante A. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheum. 2003; 48:1833–1840. PMID: 12847676.

17. Kumeda Y, Inaba M, Goto H, et al. Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis Rheum. 2002; 46:1489–1497. PMID: 12115178.

18. Simon A, Megnien JL, Levenson J. Coronary risk estimation and treatment of hypercholesterolemia. Circulation. 1997; 96:2449–2452. PMID: 9337222.

19. Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004; 350:1387–1397. PMID: 15070788.

20. Touboul PJ. Clinical impact of intima media measurement. Eur J Ultrasound. 2002; 16:105–113. PMID: 12470855.

21. O'Leary DH, Polak JF, Wolfson SK Jr, et al. CHS Collaborative Research Group. Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Cardiovascular Health Study. Stroke. 1991; 22:1155–1163. PMID: 1926258.

22. O'Leary DH, Polak JF, Kronmal RA, et al. The CHS Collaborative Research Group. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. Stroke. 1992; 23:1752–1760. PMID: 1448826.

23. Howard G, Sharrett AR, Heiss G, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke. 1993; 24:1297–1304. PMID: 8362421.

24. Gariepy J, Salomon J, Denarie N, et al. Sex and topographic differences in associations between large-artery wall thickness and coronary risk profile in a French working cohort: the AXA Study. Arterioscler Thromb Vasc Biol. 1998; 18:584–590. PMID: 9555864.

25. Wolters FL, Russel MG, Stockbrugger RW. Systematic review: has disease outcome in Crohn's disease changed during the last four decades? Aliment Pharmacol Ther. 2004; 20:483–496. PMID: 15339320.

26. Winther KV, Jess T, Langholz E, Munkholm P, Binder V. Survival and cause-specific mortality in ulcerative colitis: follow-up of a population-based cohort in Copenhagen County. Gastroenterology. 2003; 125:1576–1582. PMID: 14724807.

27. Jess T, Winther KV, Munkholm P, Langholz E, Binder V. Mortality and causes of death in Crohn's disease: follow-up of a population-based cohort in Copenhagen County, Denmark. Gastroenterology. 2002; 122:1808–1814. PMID: 12055588.

28. Mathieu P, Lemieux I, Despres JP. Obesity, inflammation, and cardiovascular risk. Clin Pharmacol Ther. 2010; 87:407–416. PMID: 20200516.

29. Pahor A, Hojs R, Gorenjak M, Rozman B. Accelerated atherosclerosis in pre-menopausal female patients with rheumatoid arthritis. Rheumatol Int. 2006; 27:119–123. PMID: 16953396.

30. Park SH, Kim YM, Yang SK, et al. Clinical features and natural history of ulcerative colitis in Korea. Inflamm Bowel Dis. 2007; 13:278–283. PMID: 17206722.

31. Kim ES, Kim WH. Inflammatory bowel disease in Korea: epidemiological, genomic, clinical, and therapeutic characteristics. Gut Liver. 2010; 4:1–14. PMID: 20479907.