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Do Celiac’s Have An Increased Risk For Heart Disease?

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As a person with celiac disease, you are probably not thinking about whether or not you will ever develop heart disease. A relatively new area of research concerns the relationship between the two conditions. The question is whether or not people with CD are at higher risk for developing ischemic heart disease. This is the type of heart disease that goes along with high blood pressure, high cholesterol, diabetes, smoking and obesity, which causes one out every five deaths in the United States.

It might even seem logical to think that some people with CD would be at lower risk of heart disease, especially those who have lost weight. Obesity is a risk factor by itself, which they do not have. Those who are not overweight are usually less likely to have type 2 diabetes, among other things.

But the damage in celiac disease is not confined to the intestine. People with celiac disease are more likely to have type 1 diabetes, because the two problems are genetically related. Type 1 diabetes is usually more severe than type 2. It comes on earlier in life, especially in people with celiac disease, and that increases the risk of heart disease.

Researchers do not know how these risk factors add up for people with celiac disease. Studies in the past have not all found the same thing. There is research that shows an increased risk of heart disease in patients with CD, but there are some studies that have not shown an increased risk.

A large study was undertaken to try and determine if CD puts a person at higher risk of developing heart disease. It was done in Sweden, which keeps track of many of its citizens with CD in a national registry. This means that the size of the group studied was big enough to show statistically significant results.

There were three groups in this study.  All had positive blood tests for celiac disease. One group consisted of over 28,000 people diagnosed with CD by biopsies that showed villous atrophy. A second group of over 12,000 people had biopsies showing inflammation but not villous atrophy. The third group (3,658 people) was made up of people who had undergone biopsy showing no abnormalities in the small intestine.

These groups were chosen for two purposes. The primary focus of the research was to determine the risk of heart disease among people with celiac disease. The second was to gather information on people with what has been called latent celiac disease. People in this group have abnormal blood tests but no villous atrophy on biopsy. The researchers were also looking at the risk of heart disease in people with latent CD, either with inflammation on biopsy or with normal biopsies.

Biopsies from a total of just under 290,000 people were available and reviewed. Biopsy results were linked with serology results to categorize them. The researchers only used data from people who had undergone all the necessary tests, meaning small intestinal biopsy and blood tests for celiac disease.

A reference group was set up for each of the three categories, made up of people that were matched by other characteristics such as age, sex, and where they lived. None had ever been biopsied for celiac disease. There were almost 230,000 people in this group. Their rate of heart disease would be compared with the rate in the other groups.

Heart disease was defined as heart attacks, angina pectoris (chest pain due to coronary heart disease) and death from heart disease. The numbers of people with these diagnoses are known in Sweden, and expected rates can be estimated.

The rates of heart disease in the three groups of patients were calculated. There were more than expected people with heart disease in all three groups. The increased risk of heart disease was in the range of 20% to 30%. The risk of death due to heart disease was similarly increased, but only in those with biopsy abnormalities. The risk was highest in the first year after diagnosis. Rates were then similar to other people of the same age and other risk factors, until 5 years or more after diagnosis. After that time, there was more heart disease in the people with celiac disease who had villous atrophy or inflammation on biopsy, but no increased risk in those with normal biopsies.

The increase in heart disease was 19% in patients diagnosed with celiac disease and villous atrophy on intestinal biopsy. The increase in patients with positive blood tests for celiac disease and inflammation on biopsy was even higher, at 28%.
The authors of this study noted that inflammation is present in celiac disease, and that heart disease is more common in people with other causes of inflammation like autoimmune diseases.

More research needs to be done to see if this risk exists in other populations. Studies in which people diagnosed with celiac disease are followed forward will give more specific and accurate information.

What Should I Do?

Rather than waiting, people with celiac disease and their doctors need to be aware of this possible risk. They should be screened for other risk factors, and treated if necessary, for high blood pressure, elevated cholesterol, anemia, and anything else that can increase the risk of heart disease.

Since treating underlying conditions helps decrease heart disease in the general population, it should also help people with celiac disease. If the excess risk is due to the disease itself, it will be important to discover if staying on a gluten-free diet lowers the risk. The gluten-free diet decreases inflammation in the intestines, and if that is the reason for the increased risk, the diet should help.

This study underscores the importance of looking at the overall health of anyone with celiac disease and trying to make sure other problems are evaluated and treated. If you have celiac disease, this information should make you want to follow the gluten-free diet for yet another reason.

References:
Ludvigsson, J. F., James, S., Askling, J., Stenestrand, U., Ingelsson, E. Nationwide Cohort Study of Risk of Ischemic Heart Disease in Patients With Celiac Disease. Circulation 2011, 123:483-490.
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