Celiac Disease May Increase Coronary Artery Disease Risk
Some basic traits of celiac disease may be responsible for increasing the risk of coronary artery disease as well as stroke in patients with the autoimmune disease, according to research presented at the American College of Cardiology’s 63rd Annual Scientific Session. This study represents the first time the relationship between these conditions has been explored.
The basic characteristics in question are chronic inflammation and the autoimmune process itself. Celiac disease is a condition in which the body’s immune system responds to the presence of gluten with inflammation.
Chronic inflammation damages the minute structures called villi in the small intestine. When the villi are damaged, the intestinal tract is unable to absorb nutrients into the bloodstream. Thus gluten (found in wheat, rye, barley, and scores of processed foods) triggers both inflammation and an immune system response.
Investigators with the new study evaluated the medical records of nearly 22.4 million patients and identified 24,530 individuals who had been diagnosed with celiac disease. Patients without the autoimmune disease were used as controls.
An analysis of the data showed that:
- Individuals with celiac disease had nearly a twofold increased risk of coronary artery disease when compared with controls; that is, the risk was 9.5 percent compared with 5.6 percent, respectively
- When the investigators considered data from individuals younger than 65 only, the trend was similar; that is, 4.5 percent compared with 2.4 percent, respectively
- High cholesterol was slightly more likely to be seen in individuals with celiac disease than it was in controls
- Individuals with celiac disease were less likely to have high blood pressure than were controls
- People with celiac disease also had a slightly higher risk of stroke than did controls
According to R.D. Gajulapalli, MD, co-investigator of the study and a clinical associate at the Cleveland Clinic, individuals with celiac disease can experience a flow of immune mediators into their bloodstream, which can ultimately result in coronary artery disease. He noted in a release that the team’s findings “reinforce the idea that chronic inflammation, whether it’s from an infection or a disease, can have an adverse role in coronary artery disease and heart health in general.”
Some previous studies have shown an association between celiac disease and heart failure and arrhythmias. In addition, recent research published in Echocardiography reported on endothelial dysfunction in celiac patients.
In patients with endothelial dysfunction, the blood vessel lining (endothelium) does not function properly. This dysfunction can cause problems with blood clotting, immune response, fluid volume, and constriction and dilation of the blood vessels. It is believed to play a major part in the development of atherosclerosis.
The bottom line
The study’s findings are important for anyone who has celiac disease, especially since, as Gajulapalli noted, the risk persists “even in the absence of traditional cardiovascular risk factors” and in younger patients as well. Therefore, individuals with celiac disease should be vigilant about following a healthful lifestyle and keeping an eye on cardiovascular risk factors such as high blood pressure, high cholesterol, smoking, and diabetes.
Another concern is the belief that as many as 83 percent of individuals with celiac disease are either misdiagnosed or underdiagnosed. Symptoms of celiac disease can be mistaken for irritable bowel syndrome, lactose intolerance, and Crohn’s disease, among other conditions.
That means there are many individuals who are not being treated properly for celiac and who also may be at risk for heart disease. Much more needs to be done to better understand celiac disease as well as its relationship with coronary artery disease and other cardiovascular conditions.
American College of Cardiology release
National Foundation for Celiac Awareness
Sari C et al. The evaluation of endothelial functions in patients with celiac disease. Echocardiography 2012 Apr; 29(4): 471-77