Recent research warns of a connection between Crohn’s disease and heart disease and stroke, but should you be worried? Here’s what the research is saying and what you can do to protect your heart if you have Crohn’s disease.
People who have an inflammatory bowel disease (IBD) such as Crohn’s disease — and women in particular — may have a slightly higher chance of having a heart attack or stroke than those who don’t have an IBD do, according to an analysis of nine studies published in March 2014 in the journal Clinical Gastroenterology and Hepatology. The researchers recommend that people with an IBD take steps to minimize other heart-health risk factors.
Another study suggested that the risk of an ischemic stroke was higher among people who have Crohn’s disease or ulcerative colitis than among people who don’t, particularly among those who had severe flares and required hospital care. The more severe the Crohn’s disease, the higher the stroke risk, according to the study, which was published in July 2014 in the European Journal of Internal Medicine.
In terms of heart disease, a third study — a review of data on 300 people with IBD in the northeast United States — found that only one person showed evidence of heart disease. The study excluded people with traditional heart disease risk factors, such as diabetes or high blood pressure. The findings were published in April 2015 in the Journal of Clinical Medicine Research. Although the researchers note that more wide-scale studies are needed, they conclude that Crohn’s disease is less of a concern for heart disease than other heart disease risk factors, such as high blood pressure and diabetes.
Determining the Link Between Crohn’s Disease and Heart Risk
What does all of this mean for people with Crohn’s disease? “You can’t say having Crohn’s disease causes heart disease, but there is an association,” says Martha Gulati, MD, clinical associate professor of cardiovascular medicine and cardiologist at the Ohio State University Wexner Medial Center in Columbus. The connection may be inflammation, she says. Crohn’s disease is a disease of inflammation of the gut, but it’s not likely that the inflammation is limited to that area — it may be throughout the body.
Inflammation itself is a risk factor for heart disease, Dr. Gulati explains. Inflammatory cells get into the walls of the blood vessels where they make cytokines, which are proteins that promote further inflammation. Cytokines recruit more inflammatory cells, perpetuating the inflammatory disease. Inflammation can also reshape those blood vessel walls with plaque deposits, commonly called hardening of the arteries. Plaque deposits are more prone to rupture because of inflammation, and a rupture can trigger a heart attack or stroke.
Other heart health risk factors run the gamut from Crohn’s disease medications to poor nutrition that might occur during flares.
It’s not uncommon to treat Crohn’s disease flares with corticosteroid drugs, saysAmar Naik, MD, a gastroenterologist who specializes in Crohn’s disease at the Loyola University Health System in greater Chicago. People who take high-dose corticosteroids long term could be at an increased risk for heart disease, he says. That’s because corticosteroids can accelerate hardening of the arteries, which can lead to heart disease. They can also cause you to retain fluid, elevating your blood pressure, a serious risk factor for heart disease.
In addition, if Crohn’s disease has you up at night running to the bathroom, you aren’t getting quality sleep, Dr. Naik says. Poor sleep is another risk factor for heart disease.
Finally, when you experience diarrhea and bloating, you may have difficulty eating a healthy, well-balanced diet. Crohn’s disease can also prevent your digestive tract from absorbing all the vitamins and other nutrients you need for a healthy heart.
Be Proactive With Crohn’s Disease to Prevent Heart Disease
Make protecting your heart a priority. “It’s hard to focus on your heart health when you are in the midst of a flare,” Gulati says. She suggests talking to your doctor about seeing a cardiologist and taking other steps to reduce your risk for heart disease when you’re feeling well and in remission.
Know your numbers — your cholesterol and your blood pressure readings — and work with your doctor to lower them if they’re high, Gulati says. If you also have diabetes, blood sugar control is essential, Naik says.
Other preventive steps include not smoking, being physically active, reducing stress, and limiting alcohol consumption, according to the American Heart Association. Smoking in particular isn’t only bad for your heart; it can also worsen Crohn’s disease symptoms. Get help if you’ve been unsuccessful at quitting smoking on your own.
Like Crohn’s disease treatment, a heart health plan should be tailored to your individual needs. Work closely with your doctor to determine the best course of action for you.