People with celiac disease may have fewer known risk factors for cardiovascular disease, but still have a higher risk of developing it, according to a study led by researchers at Oxford Population Health, published online in the journal BMJ Medicine.
It is unclear what the reasons for this might be, and more research is needed to uncover the drivers behind these associations. This includes the role of a gluten-free diet, which those affected should follow to alleviate symptoms, say the study authors.
More research is needed to uncover the drivers , including the role of the gluten-free diet, the authors say.
Around 1% of the UK population has celiac disease, an autoimmune disease caused by an overreaction to gluten, a dietary protein found in wheat, barley and rye.
The condition is more common in women and is usually diagnosed in childhood and adolescence or between ages 40 and 60, researchers say.
Published evidence on whether celiac disease is associated with an increased risk of cardiovascular disease is mixed, and previous studies have tended not to investigate the potential role of traditional cardiovascular risk factors, such as blood pressure or cholesterol.
To find out whether traditional cardiovascular risk factors could contribute to the link between celiac disease and an increased risk of cardiovascular disease (ischemic heart disease, heart attack and stroke), researchers relied on medical data provided by UK Biobank participants. United.
The UK Biobank is a population-based study that recruited around half a million people aged 40 to 69 from England, Scotland and Wales between 2006 and 2010.
Of these, 2083 had celiac disease, but not cardiovascular disease, when they were recruited. Their cardiovascular health was monitored, using linked hospital records and death certificates, for an average of just over 12 years.
People with celiac disease were more likely to be women (56% vs. 71.5%) and of white ethnicity (95% vs. 99%) than those without the condition.
During the follow-up period, 40,687 cardiovascular disease diagnoses were recorded among all surviving UK Biobank participants.
About 218 of these incidents occurred in people with celiac disease, equivalent to an annual rate of 9 in every 1,000 people, compared with an annual rate of 7.4/1,000 in people without the condition.
This translates to a 27% increased risk of cardiovascular disease for people with celiac disease compared to those without, after taking into account a wide range of lifestyle, medical, and cardiovascular disease factors. potentially influential.
The risk appeared to increase the longer a person had been living with their condition: to a 30% higher risk among those who had had celiac disease for less than 10 years, rising to a 34% higher risk among those who had had it for 10 years. or more years.
However, people with celiac disease had fewer of the known risk factors for cardiovascular disease (including overweight or obesity, high systolic blood pressure, a history of smoking, and high cholesterol) and were more likely to have a lower BMI and lower blood pressure. lower systolic blood pressure. And they were more likely to have an ideal cardiovascular risk score (23% vs. 14%) and less likely to have a poor risk score (5% vs. 9%) than people with celiac disease.
When researchers explored the possible joint effects of celiac disease and cardiovascular risk score on incident cardiovascular disease, the risk increased by more than 60% in people with celiac disease plus an ideal cardiovascular disease risk score compared to those with an ideal risk score but without celiac disease.
This is an observational study and, as such, cannot establish cause and effect. And the researchers acknowledge several limitations of their findings, including that cardiovascular disease risk factors were measured at only one point in time.
But a number of autoimmune conditions are associated with an increased risk of cardiovascular disease as a result of systemic inflammation, they note.
The researchers did not look at dietary factors, but some previously published research suggests that a gluten-free diet may reduce inflammation and therefore the risk of cardiovascular disease, while other studies indicate that this diet may increase the risk.
“This study highlights the importance of cardiovascular disease as a possible complication of celiac disease. Further investigation into the drivers and mechanistic pathways of this association is warranted.
"Additionally, investigation is warranted into the extent to which a reduced risk is reported from adherence to a gluten-free diet in people with celiac disease, or whether a gluten-free diet itself contributes to the identified increased risk," they write. .
And they conclude: “Given the increased rates of cardiovascular disease reported in people with celiac disease who have an ideal and moderate cardiovascular disease risk score, physicians should educate patients with celiac disease about their elevated risk and work with their patients. to optimize your cardiovascular health.”
What is already known about the topic?
Evidence is conflicting on whether celiac disease is associated with an increased risk of cardiovascular disease, with previous research conducted in small cohorts or using registry data sources with limited sociodemographic and lifestyle data.
Previous studies tended not to take into account traditional cardiovascular risk factors, such as blood pressure or serum total cholesterol, when examining the association between celiac disease and cardiovascular disease, despite research showing a more robust cardiovascular profile. healthy in people with celiac disease.
What does this study contribute?
People with celiac disease had a lower prevalence of traditional cardiovascular risk factors, such as systolic blood pressure, total cholesterol, and body mass index, but a higher risk of developing cardiovascular disease than people without celiac disease.
How it can affect clinical practice
Cardiovascular risk scores should adequately take into account the elevated risk among people with celiac disease; People with celiac disease and their doctors should be aware of their increased cardiovascular risk and take appropriate measures; and more research is needed to understand the mechanisms underlying these associations.
Conclusions People with celiac disease had a lower prevalence of traditional cardiovascular risk factors but had a higher risk of developing cardiovascular disease than people without celiac disease. Therefore, cardiovascular risk scores used in clinical practice may not adequately capture the excess risk of cardiovascular disease in people with celiac disease, and clinicians should be aware of the need to optimize cardiovascular health in this population. . |
