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Children with inflammatory bowel disease already have an altered arterial pulse wave

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Abstract

Adults with inflammatory bowel disease (IBD) have an increased risk for vascular events. This study aims to evaluate arterial parameters in paediatric IBD. Carotid intima-media thickness (CIMT) was measured by ultrasound, and Arteriograph was used to assess aortic pulse wave velocity (PWVao), brachial and aortic augmentation indexes (AixBrach, AixAo), central systolic blood pressure (SBPao), and heart rate (HR). A total of 161 children were included; 55 (34%) children with newly diagnosed IBD (median age 14.35 (11.88–16.31) years, 53% males), 53(33%) in remission (median age 15.62 (13.46–16.70) years, 66% males), and 53 (33%) controls (median age 14.09 (11.18–14.09) years, 55% males) were recruited into a case–control study. Compared to controls, patients with active disease and those in clinical remission had significantly lower AixBrach and AixAo (P < 0.001, P = 0.009; P < 0.001, P = 0.003). PWVao and CIMT were still normal. HR was higher in both IBD groups than in controls (P < 0.001; P = 0.006). HR positively correlated with disease duration (P = 0.001). In the ordinary least squares regression models, anti-tumour necrosis factor (TNF) α treatment predicted lower peripheral and central systolic blood pressures, in contrast to aminosalicylates and methotrexate. Aminosalicylate treatment predicted increased HR.

  Conclusion: Children with IBD have an increased heart rate, a lower augmentation index and, therefore, an altered pulse waveform. In paediatric IBD, arterial stiffness and CIMT are still normal, indicating the potential for adequate IBD treatment to preserve arterial health.

What is Known:

• Adult patients with inflammatory bowel disease (IBD) have increased carotid intima-media thickness and arterial stiffness, which positively correlates with cardiovascular risk and predicts mortality. Adequate treatment, especially anti-tumour necrosis factor (TNF) α medications, lower these risks.

• Children with IBD have impaired endothelial function and reduced heart rate (HR) variability.

What is New:

• Children with IBD have impaired endothelial function and reduced heart rate (HR) variability.

• Anti-TNFα treatment in children and adolescents with IBD lowers systolic pressure, whereas methotrexate and aminosalicylates have the opposite effect. Amiynosalyiciylate treatment also increases HR.

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Data availability

Data is available on request from the authors.

Abbreviations

Aix:

Augmentation index

AixAo:

Aortic augmentation index

AixBrach:

Brachial augmentation index

BMI:

Body mass index

CD:

Crohn’s disease

cfPWV:

Carotid-femoral pulse wave velocity

CIMT:

Carotid intima-media thickness

CRP:

C-reactive protein

DBP:

Diastolic blood pressure

EEN:

Exclusive enteral nutrition

ESR:

Erythrocyte sedimentation rate

HR:

Heart rate

IBD:

Inflammatory bowel disease

IBDU:

Inflammatory bowel disease unclassified

IQR:

Interquartile range

OLS:

Ordinary least squares

PCDAI:

Pediatric Crohn’s Disease Activity Index

PUCAI:

Pediatric Ulcerative Colitis Activity Index

PWV:

Pulse wave velocity

PWVao:

Aortic pulse wave velocity measured by Arteriograph

P1:

Forward wave

P2:

Reflected wave

SBP:

Systolic blood pressure

SBPao:

Central systolic blood pressure

UC:

Ulcerative colitis

TNF:

Tumour necrosis factor

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Acknowledgements

Special thanks to the nursing staff of the Department of Paediatrics, Children’s Hospital Zagreb, especially Višnjica Kerman, Bernarda Kovačević, Nataša Tomašić, and Katarina Kral for the kind help in collecting patients and the testing itself.

Funding

This work was supported by Croatian Science Foundation (Chronic bowel diseases in children: looking beyond the gut; grant number-IP-2019–04-3028).

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Authors and Affiliations

  1. Children′s Hospital Zagreb, Klaićeva 16, Zagreb, Croatia

    Višnja Tokić Pivac, Vesna Herceg-Čavrak, Iva Hojsak, Zrinjka Mišak, Oleg Jadrešin & Sanja Kolaček

  2. Libertas International University, Trg John F Kennedy, Zagreb, Croatia

    Vesna Herceg-Čavrak

  3. University of Zagreb, School of Medicine, Šalata 3b, Zagreb, Croatia

    Zrinjka Mišak & Sanja Kolaček

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  1. Višnja Tokić Pivac
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Contributions

All authors contributed to the study’s conception and design, material preparation, and data collection. V Tokić Pivac conducted data analysis. V Tokić Pivac wrote the first draft, and all authors read and approved the final manuscript.

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Correspondence to Višnja Tokić Pivac.

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Ethics approval

Ethical Committees at Children’s Hospital Zagreb and the University of Zagreb School of Medicine approved the study design.

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At least one parent or guardian and children older than eight had signed the informed consent.

Competing interests

Authors V Tokić Pivac, V Herceg-Čavrak, Z Mišak, and O Jadrešin have no competing interests to declare that are relevant to the content of this article. I Hojsak received payment for lectures: BioGaia, Nutricia, Biocodex, AbelaPharm, Nestle, Abbott, Sandoz, Oktal pharma, and Takeda. S Kolaček received lecture fees from Abbott, AbbVie, Abela pharm, GM Pharma, Nestle, Nestle Nutrition Institute, Nutricia, Oktal Pharma, and Takeda.

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Pivac, V.T., Herceg-Čavrak, V., Hojsak, I. et al. Children with inflammatory bowel disease already have an altered arterial pulse wave. Eur J Pediatr 182, 1771–1779 (2023). https://doi.org/10.1007/s00431-023-04858-9

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