Cardiovascular and thromboembolic risks are increasing in the population as a whole and therefore also in inflammatory bowel disease (IBD) patients. Obesity is a worldwide challenge also affecting the IBD population, and a causal association with Crohn's disease may exist. IBD itself, particularly when active, is also associated with a significant risk of thromboembolic and cardiovascular events such as myocardial infarction and stroke. Cardiovascular risk is also a significant consideration when using Janus kinase (JAK) inhibitors and sphingosine 1 phosphate (S1P) receptor modulators to treat IBD. JAK inhibitors – such as tofacitinib – are associated with several cardiovascular and venous thromboembolic risks, including hypertension and alterations in lipid profiles – specifically, increased LDL cholesterol and triglycerides – which may contribute to atherosclerosis and cardiovascular disease. S1P receptor modulators pose a slightly different set of cardiovascular risks. Initially, these drugs can cause transient bradycardia and atrioventricular (AV) block, leading to bradycardia. Moreover, they may induce QT interval prolongation, which increases the risk of life-threatening arrhythmias such as torsades de pointes. Some patients may also experience hypertension as a side effect. In this context, IBD healthcare providers need to be alert to the assessment of cardiovascular risk – particularly as cardiovascular events appear to be confined to specific patient groups with pre-existing risk factors. In addition, the potential for S1P modulator drug interactions requires a higher level of vigilance in patients with polypharmacy compared to biologics. Cardiovascular risk is not static, and updated assessment will need to become part of the routine in many IBD units.

中文翻译：

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心血管风险对 IBD 患者重要吗？

整个人群的心血管和血栓栓塞风险正在增加，因此炎症性肠病 (IBD) 患者的心血管和血栓栓塞风险也在增加。肥胖是一个世界性挑战，也影响 IBD 人群，并且可能与克罗恩病存在因果关系。IBD 本身，尤其是活跃时，也与血栓栓塞和心血管事件（例如心肌梗塞和中风）的显着风险相关。使用 Janus 激酶 (JAK) 抑制剂和 1 磷酸鞘氨醇 (S1P) 受体调节剂治疗 IBD 时，心血管风险也是一个重要考虑因素。JAK 抑制剂（例如托法替布）与多种心血管和静脉血栓栓塞风险相关，包括高血压和血脂变化（特别是低密度脂蛋白胆固醇和甘油三酯升高），这可能导致动脉粥样硬化和心血管疾病。S1P 受体调节剂带来的心血管风险略有不同。最初，这些药物可引起短暂性心动过缓和房室传导阻滞，从而导致心动过缓。此外，它们可能会导致 QT 间期延长，从而增加危及生命的心律失常（例如尖端扭转型室性心动过速）的风险。有些患者可能还会出现高血压的副作用。在这种情况下，IBD 医疗保健提供者需要对心血管风险的评估保持警惕，特别是因为心血管事件似乎仅限于具有预先存在危险因素的特定患者群体。此外，与生物制剂相比，多药治疗患者可能存在 S1P 调节剂药物相互作用，因此需要提高警惕。心血管风险不是静态的，更新的评估需要成为许多 IBD 单位常规的一部分。