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Advisor(s)
Abstract(s)
A prevalência e incidência da doença inflamatória intestinal têm vindo a aumentar com o
passar dos anos, não só em Portugal como também no resto do mundo. A sua etiologia
permanece objeto de estudo, gerando controvérsia quanto aos mecanismos envolvidos no seu
desenvolvimento e progressão. Associada a esta doença estão diversas manifestações
extraintestinais, inerentes à sua componente inflamatória sistémica, dentro das quais se
inclui atualmente a doença vascular. Eventos patogénicos como aterotrombose, vasculite,
anormalidades da coagulação e anormalidades da função plaquetária contribuem em larga
escala para o desenvolvimento de eventos cardiovasculares nestes doentes.
Dados disponíveis atualmente sugerem que os pacientes com doenças inflamatórias
sistémicas, como a doença inflamatória intestinal, têm uma prevalência aumentada de
eventos cardiovasculares quando comparados com a população em geral, levando a um
aumento da morbilidade cardiovascular e suas complicações associadas. A doença
inflamatória intestinal em específico, apresenta um aumento modesto no risco de cardiopatia
isquémica e acidente cerebrovascular, particularmente no sexo feminino e adultos jovens,
ainda que haja uma grande heterogeneidade nos estudos desenvolvidos. Este risco aumentado
encontra-se relacionado não só com a inflamação crónica sistémica presente nestes
pacientes, como também com o nível de atividade da doença.
A importância de realizar esta revisão bibliográfica parte da necessidade de colmatar uma
lacuna existente nos estudos de correlação entre doença inflamatória intestinal e eventos
cardiovasculares. Alertar os profissionais de saúde para as implicações que a doença
inflamatória intestinal pode ter a nível da principal causa de morte em Portugal, sensibilizar
para a necessidade de realizar mais estudos prospetivos nesta área e desenvolver normas
específicas de abordagem a estes doentes são metas a atingir num futuro recente.
É de extrema importância que os especialistas em doença inflamatória intestinal tenham
presente esta estreita relação entre a inflamação crónica sistémica associada a esta doença e
o risco cardiovascular aumentado, particularmente nos pacientes jovens, de modo a
alterarem a abordagem feita a estes doentes nas consultas de seguimento. Devido à falta de
normas oficiais e específicas para esta condição, os doentes com doença inflamatória
intestinal complicada por cardiopatia isquémica e/ou acidente cerebrovascular, devem ser
abordados de acordo com as normas existentes para a população geral, com as devidas
precauções de acordo com a sua condição clínica. O risco benefício das terapias aplicadas,
seja no tratamento agudo seja na prevenção secundária, deve ser sempre pesado
cuidadosamente. Terapia individualizada e estratégias para gestão da doença inflamatória
crónica, dos fatores de risco cardiovascular e das comorbidades vão permitir atingir melhores
resultados nestes pacientes.
The prevalence and incidence of the inflammatory bowel disease has been increasing with the years, not only in Portugal but also worldwide. Its etiology remains a subject of study, generating controversy as to the mechanisms involved in its development and progression. Associated with this are several extra-intestinal manifestations, inherent to its systemic inflammatory component, within which is included the vascular disease. Pathogenic events, such as atherothrombosis, vasculitis, coagulation abnormalities and platelet function abnormalities contribute largely to the development of cardiovascular events in these patients. Currently available data suggest that patients with systemic inflammatory diseases, such as inflammatory bowel disease, have an increased prevalence of cardiovascular events compared with the general population, leading to an increased cardiovascular morbidity and its associated complications. Inflammatory bowel disease in particular, shows a modest increase in the risk of ischemic heart disease and stroke, particularly in the female sex and young adults, although there is a great heterogeneity in the studies developed. This increased risk is not only associated with chronic systemic inflammation present in these patients, but also with the level of disease activity. The relevance of conducting this literature review comes from the need to bridge a gap in studies of correlation between inflammatory bowel disease and cardiovascular events. Alert health professionals to the implications that inflammatory bowel disease can have on the main cause of death in Portugal, raising awareness of the need for further prospective studies in this area, and develop specific guidelines to the management of these patients are goals to be achieved within recent future. Specialists in inflammatory bowel disease should be aware of this close relationship between chronic systemic inflammation associated with this disease, and increased cardiovascular risk, particularly in young patients, in order to alter the approach used in follow-up appointments. Due to the lack of official guidelines to this disease, patients with inflammatory bowel disease complicated by ischemic heart disease and/or stroke should be managed in accordance with existing guidelines for the general population, with proper precautions according to their clinical condition. The risk benefit of therapies applied, either in the acute treatment or in secondary prevention should always be weighed carefully. Individualized therapy and strategies for the management of chronic inflammatory disease, cardiovascular risk factors and comorbidities will help to achieve better results in these patients.
The prevalence and incidence of the inflammatory bowel disease has been increasing with the years, not only in Portugal but also worldwide. Its etiology remains a subject of study, generating controversy as to the mechanisms involved in its development and progression. Associated with this are several extra-intestinal manifestations, inherent to its systemic inflammatory component, within which is included the vascular disease. Pathogenic events, such as atherothrombosis, vasculitis, coagulation abnormalities and platelet function abnormalities contribute largely to the development of cardiovascular events in these patients. Currently available data suggest that patients with systemic inflammatory diseases, such as inflammatory bowel disease, have an increased prevalence of cardiovascular events compared with the general population, leading to an increased cardiovascular morbidity and its associated complications. Inflammatory bowel disease in particular, shows a modest increase in the risk of ischemic heart disease and stroke, particularly in the female sex and young adults, although there is a great heterogeneity in the studies developed. This increased risk is not only associated with chronic systemic inflammation present in these patients, but also with the level of disease activity. The relevance of conducting this literature review comes from the need to bridge a gap in studies of correlation between inflammatory bowel disease and cardiovascular events. Alert health professionals to the implications that inflammatory bowel disease can have on the main cause of death in Portugal, raising awareness of the need for further prospective studies in this area, and develop specific guidelines to the management of these patients are goals to be achieved within recent future. Specialists in inflammatory bowel disease should be aware of this close relationship between chronic systemic inflammation associated with this disease, and increased cardiovascular risk, particularly in young patients, in order to alter the approach used in follow-up appointments. Due to the lack of official guidelines to this disease, patients with inflammatory bowel disease complicated by ischemic heart disease and/or stroke should be managed in accordance with existing guidelines for the general population, with proper precautions according to their clinical condition. The risk benefit of therapies applied, either in the acute treatment or in secondary prevention should always be weighed carefully. Individualized therapy and strategies for the management of chronic inflammatory disease, cardiovascular risk factors and comorbidities will help to achieve better results in these patients.
Description
Keywords
Acidente Cerebrovascular Aterotrombose Cardiopatia Isquémica Doença Inflamatória Intestinal Risco Cardiovascular