Patients with inflammatory bowel disease (IBD) have an increased risk of both venous thromboembolism (VTE) and atherosclerotic cardiovascular disease (ASCVD) compared to the general population. Improved cardiovascular prevention and management strategies are of utmost importance to protect our vulnerable IBD population. Up until now, literature suggested the idea of a so-called “cardiovascular paradox” in IBD: an increased incidence of ASCVD despite similar or even lower prevalence of traditional cardiovascular risk factors. This paradox is refuted as IBD patients show unfavorable cardiovascular risk profiles that align with the metabolic syndrome. Inflammation is a promising new therapeutic target for ASCVD prevention. Cardiovascular (side)effects of IBD treatment should be taken into account in the risk-benefit balance for patient-centered clinical decision making. Prednisone and tofacitinib may increase lipid levels, in contrast to other registered IBD drugs. Therefore, routine evaluation of lipid profiles in IBD patients with active disease initiating these drugs in clinical practice is supported. Challenges in cardiovascular risk management in IBD patients include limited available guidance, and the inability of commonly used clinical risk calculators to fully capture long-term ASCVD risk. The implementation of a standardized cardiovascular screening program in daily IBD care seems feasible. Adequately designed longitudinal studies in large cohorts are essential to clarify the contribution of both traditional and IBD-related factors to excess CVD risk in IBD. The development of accurate IBD-specific risk predictors and exploring the yield of screening and interventions on ASCVD outcomes in IBD are crucial
