Objective: Chronic inflammatory bowel diseases (IBD) are associated with an increased cardiovascular risk; immunological pathways are involved in microcirculation alterations as well as in the pathogenesis of IBD. Inadequate IBD inflammation control causes intestinal microvascular disfunctions; no data are available on peripheral microcirculation which is a prognostic factor in cardiovascular risk. This prospective observational study aims to evaluate the differences in microcirculation and macrocirculation parameters between IBD patients with disease control on conventional therapy and those with active disease requiring initiation of biological therapy. Design and method: The study analyzes a sample of 29 IBD patients: 18 (62.1%) receiving conventional therapy and 11 (37.9%) requiring initiation of biological therapy. All patients underwent the assessment of retinal arteriolar morphology (wall-lumen ratio, WLR) and function (flicker-in light mode) using adaptive optics, basal and total capillary density using capillaroscopy, and arterial stiffness using PWV evaluation. Results: Baseline demographic characteristics are similar between the two groups. Regarding microcirculation and arterial stiffness evaluation, patients who started biological therapy have a significantly higher PWV than those on traditional therapy. The correlation between PWV and the group (r=0.44; p=0.019) is independent of age, blood pressure, heart rate. Moreover, there are positive correlations between age and PWV (r=0.4; p=0.03), age and WLR (r=0.57; p=0.0007), blood pressure and PWV (r=0.5; p=0.006), blood pressure and WLR (r=0.59; p=0.001). There is a negative correlation between blood pressure and flicker vasodilation (r=-0.47; p=0.029). Correlation analysis showed a positive association between WLR and PWV (r=0.39; p=0.038) and a negative association between PWV and flicker vasodilation (r=-0.43; p=0.049).Conclusions: Macrocirculation and microcirculation parameters change harmoniously, affected by the same factors such as age and blood pressure. Moreover, retinal flicker-in-light assessment shows the relationship between structural and functional parameters. Among IBD patients, those with a higher inflammatory burden have higher arterial stiffness, emphasizing how the inflammatory state can impact cardiovascular risk. Considering the relationship between macro- and microcirculation, and the potential role of macrocirculation in promoting microvascular changes, it cannot be ruled out that retinal arteriolar alterations may occur later in the disease progression.
Salvotti et al. (2026) studied this question.