Despite Fewer Known Risk Factors, Researchers Confirm Higher Risk of Cardiovascular Disease for Individuals with Celiac Disease

Individuals with celiac disease may have fewer known risk factors for cardiovascular disease, but investigators have found that they still have a heightened risk of developing the condition, according to a study published in BMJ Medicine.

The reasons for this heightened risk remain unclear, and the investigators said further research is needed to understand the drivers behind these associations. Research should also look into the role of a gluten-free diet, which is required for patients with celiac disease to ease their symptoms, according to the study.

“This study highlights the importance of cardiovascular disease as a potential complication of celiac disease,” the study authors wrote. “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 itself contributes to the increased risk identified.”

Celiac disease is an autoimmune condition caused by an exaggerated reaction to gluten, which is a dietary protein found in wheat, barley, and rye. It is more common in women and is typically diagnosed in children and adolescence or between the ages of 40 and 60 years, according to the study. Published evidence on whether celiac disease is associated with a heightened risk of cardiovascular disease is mixed, and earlier studies have tended to not investigate the potential role of traditional cardiovascular risk factors, such as blood pressure and cholesterol.

To determine whether traditional cardiovascular risk factors might contribute to the link between celiac disease and a heightened risk of cardiovascular disease (ischemic heart disease, heart attack, and stroke), investigators drew on medical data from UK Biobank participants. UK Biobank is a population-based study that recruited approximately half a million participants between 40 and 69 years of age from England, Scotland, and Wales between 2006 and 2010.

Of those approximately 500,000 participants, 2083 had celiac disease but no cardiovascular disease at the time of recruitment. Their cardiovascular health was monitored using linked hospital records and death certificates, for an average of just over 12 years.

During the monitoring period, 40,687 diagnoses of cardiovascular disease were recorded among all of the surviving UK Biobank participants. Some 218 of these incidences were in individuals with celiac disease, or the equivalent of an annual rate of 9 in every 1000 people. This is higher than the rate of 7.4 out of 1000 in those without celiac disease.

This translates into a 27% heightened risk of cardiovascular disease for individuals with celiac disease compared with those who didn’t have the condition, after accounting for a wide range of potentially influential lifestyle, medical, and cardiovascular disease factors.

The risk seemed to increase the longer a person had been living with celiac disease, with a 30% increased risk among those who had had celiac disease for fewer than 10 years and rising to a 34% risk among those who had had it for 10 years or longer.

However, people with celiac disease had fewer of the known risk factors for cardiovascular disease, such as overweight or obesity, high systolic blood pressure, a history of smoking, and high cholesterol. Individuals with celiac disease are more likely to have a lower body mass index and a lower systolic blood pressure, according to the researchers.

Individuals without celiac disease were also more likely to have a so-called ideal cardiovascular risk score and less likely to have a poor risk score than those with the disease. When the investigators explored the potential joint effects of celiac disease and cardiovascular risk score on incident cardiovascular disease, the risk increased by more than 60% in individuals with celiac disease plus an ideal cardiovascular disease risk score, compared with those with an ideal risk score but no celiac disease.

The researchers noted several limitations, particularly the fact that this was an observational study and could not establish cause and effect. Additionally, cardiovascular disease risk factors were measured at only 1 point in time.

They did not examine dietary factors, but some previously published research suggests that a gluten-free diet may reduce inflammation and therefore cardiovascular disease risk, whereas other studies indicate that this diet may actually boost the risk.

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

REFERENCE

Fewer known risk factors, but heightened risk of cardiovascular disease in people with celiac disease. EurekAlert; January 30, 2023. Accessed February 1, 2023. https://www.eurekalert.org/news-releases/977937