Arterial stiffness in inflammatory bowel disease: a systematic review and meta-analysis

Background:Arterial stiffness is increased with chronic inflammatory disorders. The reduction of inflammation by immunomodulatory therapy is associated with a restoration of arterial function. The aims of the study were to perform a meta-analysis to determine whether arterial stiffness is increased in patients with inflammatory bowel disease (IBD) and a meta-regression analysis to correlate arterial stiffness with anti-TNF therapy.Methods:Systematic review registration number: CRD42015017364. A systematic literature search for arterial stiffness in IBD was performed using PubMed, Scopus, and Google Scholar databases (last accessed on 23 September 2015). The search terms were arterial stiffness,' vascular stiffness,' or pulse wave velocity' in combination with inflammatory bowel disease,' inflammatory bowel diseases,' Crohn's disease,' or ulcerative colitis.' Inclusion criteria included peer-reviewed publications reporting original data, a minimum of 20 study participants tested, and pulse wave velocity (PWV) measured via validated devices. Publications with titles or abstracts appearing to meet the inclusion criteria were selected and reviewed by two authors according to PRISMA 2009 guidelines.Results:Carotid-femoral PWV (cf-PWV) was measured in nine cross-sectional studies (234 patients with Crohn's disease, 342 with ulcerative colitis, and 435 control study participants). Compared with control patients, cf-PWV was significantly increased in patients with Crohn's disease [mean difference 1.34 z-score; 95% confidence interval (CI) 0.71-1.97 z-score; P<0.0001] and ulcerative colitis (mean difference 1.08 z-score; 95% CI 0.55-1.61 z-score; P<0.0001). In a meta-regression analysis, cf-PWV was reduced in IBD patients treated with anti-TNF therapy ( -2.6m/s; 95% CI -4.9 to -0.2m/s; P=0.03).Conclusion:cf-PWV is increased in both ulcerative colitis and Crohn's disease patients.