A new study led by experts from Oxford Population Health and published online in BMJ Medicine indicates that people with celiac disease had an increased chance of developing cardiovascular disease.

Coeliac disease, an autoimmune disorder brought on by excessive sensitivity to gluten, a dietary protein present in wheat, barley, and rye, affects an estimated 1 in 133 Americans, or about 1% of the population.

Researchers say that the condition is more common in women and is usually found in children and teenagers or in people between the ages of 40 and 60.

Existing evidence on the link between coeliac disease and increased cardiovascular disease risk is inconsistent. Previous studies often overlooked the potential impact of traditional cardiovascular risk factors, such as blood pressure and cholesterol.

To determine if traditional cardiovascular risk factors play a role in the association between coeliac disease and increased cardiovascular disease (such as ischemic heart disease, heart attack, and stroke), the researchers utilized medical data from UK Biobank participants.

The UK Biobank is a population-based research that enrolled around half a million people aged 40 to 69 in England, Scotland, and Wales between 2006 and 2010.

When recruited, 2083 had celiac disease but no cardiovascular problems. For an average of slightly over 12 years, their cardiovascular health was tracked using linked hospital data and death certificates.

People with coeliac disease were more likely to be women (56% vs. 71.5%) and white (95% vs. 99%) than people without the disease.

During the course of the monitoring, there were a total of 40,687 cases of cardiovascular illness were identified among the UK Biobank members who were still alive.

Coeliac disease patients accounted for around 218 of these events, or about 9 in every 1000 persons on average, compared to 7.4 in every 1000 people without the illness.

After considering various lifestyle, medical, and cardiovascular disease factors, the study found Coeliac disease increases cardiovascular disease risk by 27% compared to those without.

Those who had coeliac disease for fewer than 10 years had a 30% higher risk, while those who had it for 10 or more years had a 34% higher risk.

Despite having fewer known risk factors for cardiovascular disease (such as being overweight, high blood pressure, smoking, and high cholesterol), people with coeliac disease tend to have a lower BMI and blood pressure.

Additionally, compared to those with celiac disease, they were more likely to have a so-called optimal cardiovascular risk score (23% vs. 14%) and less likely to have a bad risk score (5% vs. 9%).

An additional investigation of coeliac disease and cardiovascular risk score showed a 60% increased risk of cardiovascular disease in those with coeliac disease and ideal cardiovascular disease risk score compared to those with ideal risk score but no coeliac disease.

Since this is observational research, cause and effect cannot be established. The researchers note that their study has a number of limitations, including the fact that the risk indicators for cardiovascular disease were only assessed once.

However, they note that a variety of autoimmune disorders are linked to an increased risk of cardiovascular disease because of systemic inflammation.

Although the researchers didn’t examine dietary components, some previously published data indicates that a gluten-free diet may lower inflammation and, therefore, the risk of cardiovascular disease, while other studies show that this diet may even increase that risk.

This study emphasizes the significance of cardiovascular disease as a potential consequence of coeliac disease. Further investigation of the causes and mechanisms of this connection is necessary, according to the authors.

“In addition, an investigation is warranted into the extent to which any risk reduction is reported by adherence to a gluten-free diet in people with coeliac disease, or whether a gluten-free diet itself contributes to the increased risk identified,” they say.

“Given the increased rates of cardiovascular disease reported in people with coeliac disease who have an ideal and moderate cardiovascular disease risk score,” they advise, “clinicians should make patients with coeliac disease aware of their elevated risk, and work with their patients to optimise their cardiovascular health.”

Source: 10.1136/bmjmed-2022-000371

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