Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that mainly affects the colon, but its influence doesn’t stop there. Rising evidence shows that UC has a similar influence on the heart and blood vessels, elevating cardiovascular disease risk.

It is vital to understand this connection since maintaining heart health is just as important as controlling bowel inflammation.

Inflammation and the Heart
The driving force for this relationship is chronic inflammation. In UC, the immune system of the body is in a “permanent on” mode, producing inflammatory signals that circulate all over the body.
This inflammation can:
•Worst damage blood vessels
•Promote atherosclerosis (arrest development in arteries)
•Favor blood clotting
All of these changes increase the risk for heart attack, stroke, and other cardiovascular disease.

Cholesterol, Triglycerides, and UC
Patients with UC are likely to have abnormal lipid levels in their blood, which have an impact on cardiovascular well-being

• LDL cholesterol (“bad cholesterol”) – High levels can lead to deposition in arterial walls, further worsening plaque buildup. Some UC medications will rise levels of LDL.
• HDL cholesterol (“good cholesterol”) – Generally keeps the heart healthy by removing cholesterol from arteries. During active inflammation, levels of HDL can fall, removing this protective role.
• Triglycerides – These fats in the blood can increase with certain UC drugs (like corticosteroids or JAK inhibitors) and become a risk factor for heart disease if elevated.
  Thus, both the disease itself and the drugs used modify cholesterol and fat metabolism in several ways that affect cardiovascular health.

Drugs and Heart Health
The drugs used to treat UC inflammation are required — but they also affect heart health:

• Corticosteroids (e.g., prednisone): Can raise blood pressure, blood sugar, LDL, and triglycerides.
• JAK inhibitors (e.g., tofacitinib): Effective in UC, but evidence shows that they raise cholesterol levels (both LDL and HDL) and may slightly increase the risk of blood clots, especially at higher doses.
• Biologics (anti-TNF agents, integrin antagonists): These are more likely to reduce overall inflammation, which lowers cardiovascular risk.
  Because of the effects of these drugs, regular blood work and heart checks are required for UC patients.

How Patients Can Help Protect Their Heart
Combining UC and cardiovascular risk management must be approached from a body-as-a-whole approach:
1.Keep inflammation in check – Adhere to prescribed medication and strive for remission.
2.Monitor cholesterol and triglycerides – Blood work can identify changes before they become an issue.
3.Lifestyle choices matter – Quit smoking, eat a heart-healthy diet, exercise regularly, and manage stress.
4.Ask about medication effects – If you’re on corticosteroids or JAK inhibitors, discuss cholesterol management with your doctor.
5.See both specialists and primary care providers – A gastroenterologist treats UC, but a primary doctor or cardiologist can help keep your heart safe.

The Bottom Line

Ulcerative colitis is more than an abdomen problem — it’s an inside-out illness that may raise the risk of cardiac complications through inflammation, altered cholesterol, and drug intolerance.
Through the control of inflammation, monitoring blood lipids (LDL, HDL, triglycerides), and communication with healthcare professionals, UC patients are able to take positive steps to protect both their intestines and heart.