Fewer known risk factors, but increased risk

A study led by researchers from Oxford Population Health published online in the journal Finds that people with celiac disease may have fewer known risk factors for cardiovascular disease, but are still more likely to develop it. BMJ Medicine.

It is not clear what causes this, and more research is needed to uncover the drivers behind these associations. The study authors say this includes the role of the gluten-free diet, which those affected should follow to relieve symptoms.

About 1% of the UK population suffers from celiac disease – an autoimmune condition caused by an overreaction to gluten, a dietary protein found in wheat, barley and rye.

Researchers say the condition is more common in women and is usually diagnosed in childhood and adolescence or between the ages of 40 and 60.

The published evidence on whether celiac disease is associated with a higher risk of cardiovascular disease is mixed, and previous studies tended not to investigate the potential role of traditional cardiovascular risk factors, such as blood pressure or cholesterol.

To see whether traditional cardiovascular risk factors might contribute to the association between celiac disease and an increased risk of cardiovascular disease (ischemic heart disease, heart attack, and stroke), the researchers relied on medical data provided by participants in the UK Biobank.

The UK Biobank is a population study that recruited nearly half a million people aged 40 to 69 from England, Scotland and Wales between 2006 and 2010.

Of these, 2083 had celiac disease but no cardiovascular disease when they were recruited. Their cardiovascular health was monitored, using hospital records and associated death certificates, for an average of just over 12 years.

People with celiac disease were more likely to be women – 56% against 71.5% – and of the white race – 95% against 99% – of those who did not have this condition.

During the observation period, 40,687 diagnoses of cardiovascular disease were recorded among all UK biobank participants.

About 218 of these incidents were in people with celiac disease – equating to an annual rate of 9 in 1,000 people – compared to an annual rate of 7.4/1,000 in those without the condition.

This translates to a 27% increased risk of cardiovascular disease for people with celiac disease compared to those without it, after accounting for a wide range of potentially influencing lifestyle, medical, and cardiovascular factors.

The risk appears to increase the longer a person lives with the condition — to a 30% increased risk among those who have had celiac disease for less than 10 years, and rises to a 34% increased risk among those who have had it for 10 years. or more years.

However, people with celiac disease have fewer known risk factors for cardiovascular disease (including being overweight or obese, high systolic blood pressure, a history of smoking, and high cholesterol) and are more likely to have a lower BMI. and lower systolic blood pressure.

And they were most likely to have a so-called ideal risk score for cardiovascular disease (23%). against 14%), and less likely to be twice as severe (5%) against 9%) of patients with celiac disease.

When researchers explored potential combined effects of celiac disease and cardiovascular risk scores on incident CVD, the risk increased by more than 60% in people with celiac disease plus a perfect CVD risk score compared to those with a risk score perfect but no. Celiac disease.

This is an observational study, and therefore cannot prove cause and effect. The researchers acknowledge various limitations to their findings, including that cardiovascular disease risk factors were only measured simultaneously.

They note that a number of autoimmune diseases are associated with an increased risk of cardiovascular disease as a result of systemic inflammation.

The researchers did not look at dietary factors, but some previously published research suggests that a gluten-free diet may reduce inflammation and therefore cardiovascular disease risk, while other studies suggest that such a diet may actually increase risk.

This study highlights the importance of cardiovascular disease as a potential complication of celiac disease. Further research into the drivers and mechanistic pathways of this association is warranted.

“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 celiac disease, or whether a gluten-free diet contributes to an increased risk identified,” they wrote. .

They concluded: “Given the increased rates of cardiovascular disease reported in people with celiac disease who have ideal and intermediate cardiovascular risk, clinicians should educate patients with celiac disease of their elevated risk, and work with their patients To improve cardiovascular health.”

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