Think ulcerative colitis and heart disease are unrelated? Think again. Learn about your heart risk and how to minimize it.
By Beth W. Orenstein
Medically reviewed by Pat F. Bass III, MD, MS, MPH
You know that ulcerative colitis can cause bouts of diarrhea, pain, fever, and fatigue, and that those with the condition can feel fine one day and experience a flare of symptoms the next. But here’s what you might not know: Flares of ulcerative colitis may also put you at increased risk for heart disease or stroke.
In 2013, Danish researchers published a study that found that people with an inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn’s disease, are at increased risk of a heart attack, stroke, and cardiovascular-related death. The risk for heart events was highest during flares.
A year later, the same research team found that the risk of hospitalization from heart failure was 37 percent higher for people with IBD than for the general population — and risk more than doubled during a flare or persistent disease activity.
A separate study team calculated the risk of stroke and heart attack among people with IBD by looking at data from 150,000 patients in nine studies. They found that those with IBD had a 10 to 25 percent higher risk of stroke and heart attack than the general population, and that the risk was the greatest among women and people younger than 40.
Explaining the Link Between Ulcerative Colitis and Heart Disease
There are several potential causes for increased heart risk among those with ulcerative colitis:
Inflammation. Poneh Rahimi, MD, a gastroenterologist at St. Joseph Health Mission Hospital in Mission Viejo, California, suspects that inflammation is the common denominator between ulcerative colitis and heart disease. Ulcerative colitis causes long-lasting inflammation in the colon and small intestine. When they’re inflamed, cells release cytokines, small proteins that regulate the body’s response to disease and infection. Dr. Rahimi explains that cytokines floating throughout the body could cause atherosclerosis, or hardening and narrowing of the arteries, which leads to heart attack and strokes.
Inflammation in the body is not limited to your colon, says Girish Anand, MD, a gastroenterologist with Atlanta Gastroenterology Associates. “You’re producing inflammation triggers throughout your body, and they can affect the vessels supplying your heart.”
Dehydration. Another possible explanation for the link is the dehydration that can occur from severe diarrhea, says Twan Phanijphand, DO, a gastroenterologist with St. Anthony’s Gastroenterology Specialists in St. Louis. “When you’re dehydrated, you have less blood volume and, as a consequence, less blood flow to the heart,” Dr. Phanijphand explains.
Medication. Steroids reduce inflammation and are often used to treat ulcerative colitis flares, but prolonged steroid use could potentially lead to heart problems. Talk to your doctor about your heart health risk if you’re taking corticosteroids.
Keep Your Heart Healthy
Work with your doctor to control your risk factors for heart disease and manage flares of ulcerative colitis. Start by following these steps:
Manage your condition. Focus on following your treatment plan to stay in remission and, in turn, protect your heart. Always take your medications as directed by your doctor. If you stop taking them, you risk flaring.
Control your stress. Stress doesn’t cause ulcerative colitis, but it can make symptoms worse while also putting a strain on the heart. Find stress-relieving techniques that work for you. Consider meditation, yoga, tai chi, massage, exercise, or relaxation methods such as deep breathing.
Eat a heart-healthy balanced diet. Fresh fruits and vegetables and high-fiber foods are good for your heart — but they might be taxing on your digestive system. Consider working with a nutritionist to create a diet plan that is best for your gut and your heart, taking into account any foods that are flare triggers for you. During flares, you may not be absorbing all the vitamins and nutrients from your food, so your doctor or nutritionist may recommend vitamin and nutritional supplements.
Get moderate exercise. Exercise is a stress-buster. It also helps to keep your heart pumping and your digestive system functioning at its peak.
If you smoke, quit. You may have heard that nicotine helps prevent ulcerative colitis from flaring, but there are too many other risks associated with smoking — especially its effect on heart health — to make it worthwhile.
Know your numbers. “If you are over 40, get your cholesterol checked,” Rahimi advises. Discuss the results with your doctor so that you can keep your cholesterol within a heart-healthy range. If you have diabetes, work to keep your blood sugar under control as well, she says.
Know the warning signs of heart failure. If you develop symptoms of heart failure such as shortness of breath, swollen ankles and feet, and fatigue, seek help immediately.
Last Updated: 08/25/2014