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Bowel resection reduces aortic pulse wave velocity in patients with ulcerative colitis. A longitudinal study

Published:August 05, 2020DOI:https://doi.org/10.1016/j.ejim.2020.08.001
      Ulcerative colitis (UC) is characterized by an involvement of the large bowel which leads to chronic systemic inflammation, increased aortic stiffness and reflected waves [
      • Zanoli L
      • Cannavò M
      • Rastelli S
      • et al.
      Arterial stiffness is increased in patients with inflammatory bowel disease.
      ,
      • Zanoli L
      • Rastelli S
      • Inserra G
      • et al.
      Increased arterial stiffness in inflammatory bowel diseases is dependent upon inflammation and reduced by immunomodulatory drugs.
      ,
      • Zanoli L
      • Boutouyrie P
      • Fatuzzo P
      • et al.
      Inflammation and aortic stiffness: an individual participant data meta-analysis in patients with inflammatory bowel disease.
      ,
      • Zanoli L
      • Granata A
      • Lentini P
      • et al.
      Augmentation index is increased in patients with inflammatory bowel disease, a meta-analysis.
      ] and an excess of cardiovascular events [
      • Singh S
      • Singh H
      • Jr Loftus EV
      • et al.
      risk of cerebrovascular accidents and ischemic heart disease in patients with inflammatory bowel disease: a systematic review and meta-analysis.
      ]. A recent expert panel statement suggests that aortic stiffness is an extraintestinal manifestation of UC caused by chronic inflammation [
      • Zanoli L
      • Mikhailidis DP
      • Bruno RM
      • et al.
      Aortic stiffening is an extraintestinal manifestation of inflammatory bowel disease: review of the literature and expert panel statement.
      ]. In this regard, the arterial phenotype of patients with UC is characterized by an increase of both muscular and elastic artery stiffness [
      • Zanoli L
      • Lentini P
      • Boutouyrie P
      • et al.
      Pulse wave velocity differs between ulcerative colitis and chronic kidney disease.
      ]. A similar arterial phenotype has been described in other groups of patients with chronic inflammation [
      • Zanoli L
      • Briet M
      • Empana JP
      • et al.
      Vascular consequences of inflammation: a position statement from the ESH working group on vascular structure and function and the ARTERY society.
      ]. Interestingly, aortic pulse wave velocity (aPWV), a well-validated measure of aortic stiffness, is reduced by anti-tumour necrosis factor therapy in patients with UC [
      • Zanoli L
      • Ozturk K
      • Cappello M
      • et al.
      Inflammation and aortic pulse wave velocity: a multicenter longitudinal study in patients with inflammatory bowel disease.
      ], suggesting that the reduction of inflammation is of benefit to the arterial wall in these patients. Moreover, this therapy seems to be more effective in patients with a recent diagnosis of UC [
      • Zanoli L
      • Inserra G
      • Cappello M
      • et al.
      Aortic stiffness in patients with inflammatory bowel disease reduced after anti-tumor necrosis factor therapy.
      ]. Here we tested the hypothesis that bowel resection, a definitive therapy of ulcerative colitis, reduces aPWV in these patients.

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