Disease Activity as A Risk Factor for Increased Arterial Stiffness in Patients with Ulcerative Colitis

Objective. We aimed to study the parameters of arterial stiffness and its variability during 24-hour monitoring in relation to the clinical and endoscopic activity of ulcerative colitis. Materials and methods. This cross-sectional retrospective study involved 100 patients with ulcerative colitis (mean age 40 [33; 49] years, 38 (38 %) men, disease duration >1 year, without concomitant cardiovascular diseases or metabolic disorders) and 50 healthy control subjects. Arterial stiffness parameters were assessed via 24-hour ambulatory blood pressure monitoring with Vasotens technology. Based on disease activity patients were divided into 3 groups: Group 1 included 30 patients in clinical and endoscopic remission; Group 2 consisted of 22 patients in clinical remission with endoscopic activity; Group 3 included 48 patients with both clinical and endoscopic exacerbation. Statistical analysis was performed using the software package “IBM SPSS Statistics Version 25.0”. Results. Increased arterial stiffness (aortic pulse wave velocity (PWVао) >10 m/s) was detected in 67 (67 %) of ulcerative colitis patients, which was significantly higher than in the control group (OR = 4.74; p<0.001). The most pronounced alterations were observed in the group with clinical-endoscopic exacerbation, which showed increased aortic pulse wave velocity at systolic blood pressure (SBP)=100 mmHg and heart rate (HR)=60 bpm (PWVао 100-60) (p=0.003), augmentation index adjusted for HR=75 bpm (AIx75) (p<0.001), and PWVао variability (p=0.002). In endoscopically active disease without clinical symptoms, AIx75, PWVао100-60, and variability of the rate of increase in blood pressure in the aorta (dP/dt var.) were significantly higher compared to controls. Logistic regression analysis identified age >40 years (p=0.001; 95 % CI: 2.045 to 15.309), disease activity of ulcerative colitis (p=0.025; 95 % CI: 1.151 to 8.200), and a positive family history of cardiovascular disease (p=0.033; 95 % CI: 1.131 to 17.312) as independent predictors of increased arterial stiffness in patients with ulcerative colitis. The prediction model demonstrated good performance: аrea under the ROC curve (AUC) = 0.76 ± 0.051 (95 % CI: 0.66–0.86), sensitivity 0.851, specificity 0.638, and accuracy 0.747 (p <0.001) and can be implemented in practice for the early identification of patients with high cardiovascular risk. Conclusion. Patients with ulcerative colitis exhibit a significant increase in arterial stiffness, which correlates with the degree of inflammatory activity. Endoscopic activity, even in the absence of clinical symptoms, is associated with adverse vascular changes. The developed predictive model, based on three clinical criteria (age >40 years, active ulcerative colitis, and positive family history), could be implemented clinically for the early identification of high cardiovascular risk in this patient population.

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