Patients with Celiac Disease Had Higher CVD Risk, Despite Lower Risk Factor Prevalence

Patients with celiac disease had a lower prevalence of traditional cardiovascular risk factors, but a higher risk of developing cardiovascular disease (CVD) than those without celiac disease, according to a recent analysis.

The analysis adjusted for a wide range of lifestyle, medical, and cardiovascular risk factors, but ultimately reported the increased CVD risk was not explained by these traditional risk factors. However, risk was shown to increase as time since celiac disease diagnosis increased, suggesting the longer the exposure, the higher the risk.

“Given the increased rates of CVD reported in people with celiac disease who have an ideal and moderate CVD risk score, clinicians should make patients with celiac disease aware of their elevated risk, and work with their patients to optimize their cardiovascular health,” wrote corresponding author Megan Conroy, Nuffield Department of Population Health, University of Oxford.

There are conflicting findings on the association of celiac disease with CVD risk, largely based on case-control, cross sectional, or longitudinal studies without complete information on cardiovascular risk factors and other potentially confounding factors. The current prospective analysis investigates this association using UK Biobank data, as well as assesses whether any association is independent of traditional CVD risk factors.

The UK Biobank is a population-based cohort study that recruited approximately 500,000 adults aged 40 – 69 years from England, Scotland, and Wales between 2006 and 2010 without CVD at baseline. Of the 469,095 patients included in the study, 2083 participants had celiac disease.

The main outcome for the analysis was a composite CVD outcome, consisting of ischemic heart disease, myocardial infarction, and stroke in people with celiac disease, compared with those who do not have celiac disease. It used Cox proportional hazards models to calculate the hazard ratio (HR) for the CVD outcomes of interest.

Compared with those who do not have celiac disease, participants with celiac disease had a lower body mass index, were less likely to smoke, and were more likely to have an ideal cardiovascular risk score. Over a median follow-up of 12.4 years, 40,687 CVD events, 33,556 ischemic heart disease events, 8859 stroke events, and 12,853 myocardial infarction events were identified.

Upon analysis, the data show participants with celiac disease had a higher absolute incidence of CVD (9.03 per 1000 person-years; 95% confidence interval [CI], 7.90 to 10.31) compared with people with no celiac disease (7.4 per 1000 person-years [95% CI, 7.3 to 7.4]).

Celiac disease was associated with a 27% increased CVD risk compared to those without celiac disease (HR, 1.27; 95% CI, 1.11 to 1.45). Investigators noted the results were not influenced by adjusting for lifestyle factors (HR, 1.27), but adjustment for cardiovascular risk factors strengthened the association (HR, 1.44; 95% CI, 1.26 to 1.65).

They added that the pattern of associations was similar for ischemic heart disease and myocardial infarction. Fewer stroke events occurred than for other endpoints and no association was found between celiac disease and the risk of stroke.

Suggestions of a dose-response association between time since celiac disease diagnosis and risk of CVD were additionally reported in the analysis. Those with celiac disease for less than 10 years had a 30% increased risk and people with celiac disease for 10 years or more had a 34% increased risk.

Then, when investigating the potential joint effects of celiac and cardiovascular risk score and incident CVD, people with celiac disease and an ideal risk score had more than 60% increased risk (HR, 1.64; 95% CI, 1.14 - 2.35; P = .007) compared with people with no celiac disease and an ideal risk score.

“This study highlights the importance of CVD as a potential complication of celiac disease,” Conroy wrote. “Further research into the drivers and mechanistic pathways of this association is warranted.”

The study, “Association between celiac disease and cardiovascular disease: perspective analysis of UK Biobank data,” was published in BMJ Medicine.