Inflammatory bowel disease and the heart: how trained immunity shapes cardiovascular outcomes

Abstract

Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic relapsing intestinal inflammatory disorder. Cardiovascular disease (CVD) is a leading cause of death in patients with IBD, with elevated risks of myocardial infarction, heart failure, stroke, and venous thromboembolism that are independent of traditional risk factors. Disease activity and histological inflammation independently predict major adverse cardiovascular events, and Crohn’s disease and ulcerative colitis differ in cardiovascular risk profiles. This residual risk points to immune mechanisms that remain unclear. Trained immunity (TI), an innate immune memory induced by epigenetic and metabolic reprogramming, may link chronic intestinal inflammation to cardiovascular injury. This review integrates epidemiological and mechanistic evidence, outlines cardiovascular risk features in IBD, examines the molecular basis of TI and its roles in atherosclerosis, myocardial injury, and heart failure, and evaluates candidate biomarkers and targeted therapeutic strategies. We also discuss current limitations and challenges in clinical translation and propose future research directions, to inform mechanistic studies and clinical interventions for IBD-associated CVD.