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THROMBOEMBOLIC AND CARDIOVASCULAR RISK PROFILES IN ULCERATIVE COLITIS PATIENTS INITIATING ADVANCED THERAPIES: A SINGLE-CENTER STUDY

VALENTIN CALVEZ 1, Giuseppe Cuccia 1, Angelo Del Gaudio 1, Ivan Capobianco 1, Laura Parisio 1, Antonio Gasbarrini 2, Franco Scaldaferri 1, Luigi Carbone 3, Daniela Pugliese 4

Affiliations

1 Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome, Rome, Italy

2 Fondazione Policlinico Universitario Gemelli IRCCS, Università’ Cattolica, Rome, Italy

3 Ospedale Isola Tiberina Gemelli Isola, Rome, Italy

4 Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy

Summary

AI Generated

A single-center survey of 305 ulcerative colitis patients initiating advanced therapies found a low prevalence of cardiovascular and thrombotic risk factors, with only 1.65% having more than three cardiovascular risk factors.

Among 305 UC patients (mean age 45 years, 21.3% elderly), 30.2% had one cardiovascular risk factor, 5.6% had two, and 1.65% had more than three.
Prevalence of individual cardiovascular risk factors was low: 15.1% hypertensive, 4.9% diabetic, 4.3% history of myocardial infarction, 1.3% history of stroke or TIA.
For thrombotic risk factors, 8.8% had four risk factors, 3.6% had five, and 2% had six or more; genetic thrombophilic predisposition was present in 4.6%.
The authors conclude that concerns about JAK inhibitor cardiovascular risk observed in older rheumatoid arthritis cohorts may not apply to UC patients, who show lower baseline risk.
This material is relevant for gastroenterologists and IBD specialists considering advanced therapies, particularly JAK inhibitors, in ulcerative colitis patients.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Inflammatory bowel disease (IBD) especially during flare periods, seems to be associated with an increased risk of thromboembolic and cardiovascular (CV) events[1]. After the results of the ORAL Surveillance study[2] enrolling patients with rheumatoid arthritis, several concerns have also been raised on the intrinsic risk of Janus kinase inhibitors (JAK-i), but population enrolled was predominantly >50 years old and had several CV risk factors. Accordingly, regulatory agencies recommend that JAK-i should be used only if no suitable treatment alternatives are available in patients at increased CV risk for all indication[3]. However, the real prevalence of CV risk factors (CVRF) and the risk related to JAK-i seem to be lower for patients with Ulcerative Colitis (UC).

Aims & Methods

The aim of our study is to explore the prevalence of thromboembolic and CV risks factors in a large cohort of UC patients suitable for advanced therapies.
We conducted a single-center study including all consecutive adult patients with UC, who initiated advanced therapies from June 2020 to December 2023. To assess thrombosis and CV risks, an online questionnaire was administered, collecting following variables: BMI, smoking status, varicose vein (presence or previous surgery), personal or family history of (FHx) venous thromboembolism (VTE), presence of known genetic thrombophilic factors, active or previous cancer, admission to hospital in the last 6 months, leg or hip fractures or surgery in the last month, C reactive protein (CRP) serum levels, history of (h/o) abortion, ongoing treatment with estrogen or hormone replacement therapy (HRT), presence of heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, h/o acute myocardial infarction (AMI), hypertension, atrial fibrillation (AF), h/o stroke or TIA, diabetes, FHx CV disease and serum lipids levels. The International Physical Activity Questionnaire (IPAQ) was used to assess sedentary lifestyle.

Results

Out of 320 patients surveyed, 305 responded (95.3%): of whom 54% male, with a mean age was 45 years (±SD 15.4) and a median disease duration of 7 years (IQR 2.9-16). Elderly patients (≥60 years) were 21.3%. The average BMI was 23.9 (±SD 14.1), with 34.8% being overweight and 8.5% obese. Active and former smokers accounted for 19.7% and 41.6% of the cohort, respectively; 54.1% were sedentary. Overall, 119 patients (39%) were biologic-naïve; 21.6% of patients started a JAK-i. Overall, 19% were recently hospitalized and in 86% of cases for IBD-related reasons. A genetic predisposition for thrombosis was identified in 4.6% of patients; varicose vein disease in 14.1%. CRP was high in 44.9% of patients. Of the female population 17.9% had h/o abortion, 7.1% were taking estrogen and 2.1% in HRT. Cumulatively only 27 patients (8.8%) had 4 thrombotic risk factors, 11 (3.6%) five, and 6 (2%) had ≥6.
Regarding CV risks, 15.1% of the population were hypertensive, 4.9% were diabetic, 4.3% had h/o AMI, 1.3% had h/o stroke or TIA, 2.3% had AF and 3.9% had CKD stage III. Total cholesterol values were available for 212 patients (69.5%), and 8% had cholesterol >240 mg/dl. The total cholesterol/HDL ratio was available for 171 patients (56.1%); 10.5% had values > 5 (medium risk). Overall, 92 (30.2%) had 1 CVRF, 17 (5.6%) had 2 CVRF, and 5 patients (1.65%) had more than 3 CVRF.

Conclusion

Our study confirms the prevalence of thrombotic and CV risk factors among patients affected by UC is quite low. Accordingly, the concerns regarding the use of JAK-i observed in rheumatological cohorts, may not be applicable for patients with UC.

References

[1] Fumery M, Xiaocang C, Dauchet L, Gower-Rousseau C, Peyrin-Biroulet L, Colombel J-F. Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases: A meta-analysis of observational studies. Journal of Crohn’s and Colitis 2014;8:469–79. https://doi.org/10.1016/j.crohns.2013.09.021.
[2] Ytterberg SR, Bhatt DL, Mikuls TR, Koch GG, Fleischmann R, Rivas JL, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med 2022;386:316–26. https://doi.org/10.1056/NEJMoa2109927.
[3] EMA confirms measures to minimise risk of serious side effects with Janus kinase inhibitors for chronic inflammatory disorders | European Medicines Agency n.d. https://www.ema.europa.eu/en/news/ema-confirms-measures-minimise-risk-serious-side-effects-janus-kinase-inhibitors-chronic-inflammatory-disorders (accessed April 25, 2024).

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

Risk factors and treatment side effects in IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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