Anxiety, depression link to aortic stiffness suggests brain–gut–vascular axis in Crohn's disease

The associations of anxiety, depression, and chronic inflammation with aortic pulse wave velocity (aPWV) and systolic blood pressure (SBP) indicate the first evidence of a brain–gut–vascular axis and new potential targets for treatment in patients with Crohn’s disease (CD), reveals a study.

The authors performed a mediation analysis to reveal the potential connection between anxiety, depression, and aortic stiffness in CD patients in this multicentre observational cross-sectional study. They analysed 86 consecutive patients with CD and 86 matched control individuals.

Partial least squares structural equations modelling was used to test the connections between anxiety, depression, disease duration, aPWV, and brachial and central SBP.

Anxiety (path coefficient, 0.220; p=0.01) and disease duration (path coefficient, 0.270; p=0.02) correlated with aPWV, which in turn was associated with brachial SBP (path coefficient, 0.184; p=0.03) in CD patients. Such connections were more robust in those with active disease.

Central SBP (indirect effect, 0.090; p=0.01; indirect-to-total effect ratio, 41 percent) partly mediated the association between anxiety and aPWV, as did sympathetic hyperactivity in a pilot substudy. In patients with CD, anxiety and depression were highly associated. Results were confirmed when anxiety was substituted by depression.

“Patients with CD have an increased aortic stiffness, a known cardiovascular risk factor,” the authors said. “Anxiety, a key factor of the brain--gut axis in patients with CD, is implicated in the pathogenesis and progression of the disease and is linked with aortic stiffening in other clinical settings.”