The link between ulcerative colitis and heart disease

UC is a chronic autoimmune disease that is associated with systemic inflammation. In general, inflammation plays an important protective role in the body. However, the prolonged, elevated levels of inflammation that occur with UC can lead to additional health issues.

In a 2022 study, researchers investigated the relationship between IBD and heart disease, focusing on the role of inflammation.

The researchers found sufficient evidence to conclude that inflammation associated with IBD plays a role in atherogenesis, or the formation and buildup of plaque in the arteries. These elevated plaque levels increase a person’s risk of developing coronary heart disease.

A systematic review of literature from 2022 found sufficient evidence to suggest that inflammatory conditions, including IBD, increase the risk of:

• atrial fibrillation
• heart failure
• atherosclerotic cardiovascular diseases

They suggest people with IBD should receive care from a multidisciplinary team that includes both gastroenterologists and cardiologists for optimal care.

IBD and heart disease share some similar risk factors, including:

• Smoking: Smoking increases the risk of another form of IBD known as Crohn’s disease. However, it also shows a protective effect against UC. This does not suggest smoking is a healthy habit for people with UC since it still increases a person’s risk of heart disease and several other health conditions.
• Diabetes: IBD increases the risk of diabetes, which increases a person’s risk of heart disease.
• Diet: Consumption of large amounts of saturated fats increases the risk of both IBD and atherosclerotic cardiovascular diseases.
• Obesity: People with obesity have an increased risk of both IBD and heart disease. However, the risk may be greater for the development of Crohn’s disease compared to UC.
• Cholesterol levels: People living with IBD are also more likely to have the following factors, which also increase heart disease risk:
  • high triglycerides
  • high LDL, also known as “bad” cholesterol
  • low HDL, also known as “good” cholesterol

It is important to remember that risk factors include anything that increases a person’s risk of developing a disease or condition. They do not mean a person will eventually develop a condition — individuals with no known risk factors can still develop it.

The gut microbiome is a collection of millions of bacteria and other microorganisms that live in the intestines. The microbiome helps with the digestion of food and absorption of nutrients and may affect several aspects of a person’s health.

Changes in the gut microbiome may be a risk factor for both UC and heart-related conditions. Some evidence suggests that inflammation of the mucosa in the intestines may release microbial products into the body through a disruption of the intestinal barrier. These products may influence and add to plaque formation in the arteries.

As such, researchers are showing an increasing interest in the gut microbiome both for UC and heart disease. Both conditions may benefit from treatments that address imbalances or dysfunction within this complex system.

The American Gastroenterological Association recommends several medications to treat UC, such as:

• immunomodulators
• biologics
• janus kinase (JAK) inhibitors

These drugs suppress inflammation in the body to help reduce the frequency of flares, decrease disease activity, and help relieve symptoms of UC.

As such, UC treatments may positively affect heart disease risk by lowering inflammation in the body. However, few studies have explored the exact benefit. Still, experts suggest that heart disease risk will decrease with proper UC treatment.

Evidence suggests that taking steps to manage UC can help reduce heart disease risk.

A 2021 study provided some tips to reduce the risk of atherosclerotic cardiovascular disease in people with IBD, including:

• meeting with a multidisciplinary team to create a well-rounded treatment approach
• getting regular screenings for heart disease
• taking actions to reduce cardiovascular risk
• utilizing treatments that aim for remission
• considering IBD as a risk factor when discussing whether to start statin therapy

In other words, a person can reduce their risk of heart-related complications by managing UC with a thorough treatment plan.

Tips for a healthy lifestyle

Common tips to reduce cardiovascular risk often include making dietary changes that promote heart health. This often presents a challenge for people living with UC due to digestive issues associated with heart-healthy foods, such as those high in fiber, as well as a natural desire to limit foods that aggravate symptoms.

A systematic review of studies from 2022 found some evidence to suggest that the Mediterranean diet may provide the best option for people living with IBD due to its influence on the gut microbiome and overall body function.

Strong evidence also suggests that the traditional Mediterranean diet helps with cardiovascular outcomes, which includes lowering risks of total cardiovascular disease, coronary heart disease, and ischemic stroke.

Therefore, following a Mediterranean diet may help with both UC symptoms as well as improving heart health.

Other lifestyle modification tips that may help with quality of life for people with UC, such as regular exercise and taking steps to manage stress, may also help with heart health.

Living with UC can increase your risk of other health conditions, including heart disease. Underlying inflammation in the body, changes in the gut microbiome, and other risk factors can all play a role in the relationship between UC and heart health.

Understanding this link can help people take the necessary steps to manage UC and promote heart health.