| Abstract | Kronične upalne bolesti crijeva (IBD) povezane su s preuranjenom aterosklerozom uzrokovanom
disfunkcijom endotela i povećanjem intime-medije krvnih žila. Upravo u stanjima kronične
sustavne upale, kao što je IBD, kroz prisutnost dislipidemije i ubrzane ateroskleroze u sklopu
podležećeg upalnog procesa dolazi do povišene krutosti velikih arterija. Uloga krutosti arterija u
razvoju kardiovaskularnih bolesti dobro je poznata, a određivanje krutosti arterija sve se više
upotrebljava u kliničkoj praksi u svrhu procjene kardiovaskularnog rizika u bolesnika, te je jedan
od pokazatelja vaskularnog starenja. Neinvazivno mjerenje brzine pulsnog vala aorte (eng. pulse
wave velocity, PWV) i augmentacijskog indeksa (Aix) ima prediktivnu vrijednost za otkrivanje
budućih fatalnih kardiovaskularnih incidenata, kao i za ukupni kardiovaskularni rizik. Ovim
istraživanjem utvrđeno je kako gotovo polovica svih ispitanika (54(45%)) ima povišenu vrijednost
PWV, odnosno prisutno supkliničko oštećenje ciljnih organa. U našoj kohorti IBD bolesnika nije
bilo razlika u markerima krutosti arterija između pacijenata s ulceroznim kolitisom i Crohnovom
bolešću, kao ni u ovisnosti o fenotipu, lokalizaciji bolesti ili primijenjenoj terapiji. Prisutnost
povišene PWV (>8 m/s, 45% bolesnika) najprevalentniji je marker supkliničkog oštećenja ciljnih
organa u našoj kohorti IBD bolesnika, a PWV raste s dobi te postaje viši u odnosu na kontrolnu
skupinu ispitanika s dobro liječenom arterijskom hipertenzijom. Ubrzano vaskularno starenje
rezultat je produljenog trajanja IBD kao vjerojatnog uzroka povišene PWV, a bolesnici su imali i
povišen Aix, kao marker povišene krutosti arterija srednje velikih i malih arterija. U svim
skupinama bolesnika upravo su dob i duljina trajanja IBD bili snažni, neovisni prediktori povišene
PWV. Ovi rezultati pokazuju da IBD s prisutnom kroničnom, sustavnom upalom ima sličnu ulogu
u razvoju ubrzane ateroskleroze, povišene krutosti arterija i supkliničkog oštećenja ciljnih organa,
kao i arterijska hipertenzija, etablirani rizični faktor za povišenu krutost arterija. Također, može se
zaključiti da je porast krutosti arterija i ubrzano vaskularno starenje više izraženo u onih bolesnika
s duljim trajanjem IBD. Naši rezultati povišene PWV i Aix u pacijenata s duljim trajanjem IBD
govore u prilog činjenici da je kronična sustavna upala odgovorna za promjene u velikim i malim
arterijama i dovodi do oštećenja ciljnih organa u ovih bolesnika, neovisno o trenutnom statusu
aktivnosti bolesti. Preuranjena ateroskleroza i prisutnost dislipidemije moraju biti adekvatno
nadzirane i liječene, posebice u onih IBD bolesnika s duljim trajanjem bolesti. |
| Abstract (english) | Chronic inflammatory bowel diseases (IBD) are associated with premature atherosclerosis caused
by endothelial dysfunction and increased arterial intima-media. In conditions characterized by
chronic systemic inflammation, like IBD, chronic inflammatory process through dyslipidemia and
accelerated atherosclerosis leads to increase in arterial stiffness of the large arteries. The crucial
role of arterial stiffness in the development of cardiovascular disease is well known and arterial
stiffness measurement is increasingly being used for cardiovascular risk assessment and it is an
indicator of vascular aging. Non-invasive measurement of pulse wave velocity (PWV) and
augmentation index (Aix) has predictive value for future fatal cardiovascular events and overall
cardiovascular risk. In our research, nearly half of the examinees had increased PWV (45%) and
subclinical target organ damage. There were no differences in arterial stiffness markers in Crohn's
disease (CD) and ulcerative colitis (UC) patients. Also, patients divided according to disease
phenotype, localization and applied therapy showed no differences in PWV and Aix markers.
Increased PWV (>8m/s) is the most prevalent marker of subclinical target organ damage in our
IBD patient cohort. We also showed that PWV increases with age and becomes higher than PWV
in the control group of examinees with well-controlled arterial hypertension. Accelerated vascular
aging is the result of prolonged duration of IBD as the most plausible cause of increased PWV.
Patients also had increased Aix as a marker of increased arterial stiffness of medium and small
arteries. Age and duration of IBD were strong and independent predictors of increased PWV in all
groups of IBD patients. These results show that IBD with chronic, systemic inflammation plays a
role in the development of accelerated atherosclerosis, increased arterial stiffness and subclinical
target organ damage similar to arterial hypertension, an established risk factor for arterial stiffness.
Also, we can conclude that increased arterial stiffness and accelerated vascular aging are more
pronounced in those patients with a more prolonged duration of IBD. Our results of increased PWV
and Aix in IBD patients with longer disease duration are contributing to the fact that chronic
inflammation is responsible for alterations of both large and smaller arteries and leads to target
organ damage in these patients, regardless of current disease activity. Premature atherosclerosis
and dyslipidemia should be closely monitored and treated, especially in IBD patients with longer
disease duration. |
