Cardiovascular involvement in celiac disease

Abstract

Celiac disease (CD) is an autoimmune response to ingestion of gluten protein, which is found in wheat, rye, and barley grains, and results in both small intestinal manifestations, including villous atrophy, as well as systemic manifestations. The main treatment for the disease is a gluten-free diet (GFD), which typically results in the restoration of the small intestinal villi, and restoration of other affected organ systems, to their normal functioning. In an increasing number of recently published studies, there has been great interest in the occurrence of alterations in the cardiovascular system in untreated CD. Herein, published studies in which CD and cardiovascular terms appear in the title of the study were reviewed. The publications were categorized into one of several types: (1) articles (including cohort and case-control studies); (2) reviews and meta-analyses; (3) case studies (one to three patient reports); (4) letters; (5) editorials; and (6) abstracts (used when no full-length work had been published). The studies were subdivided as either heart or vascular studies, and were further characterized by the particular condition that was evident in conjunction with CD. Publication information was determined using the Google Scholar search tool. For each publication, its type and year of publication were tabulated. Salient information from each article was then compiled. It was determined that there has been a sharp increase in the number of CD - cardiovascular studies since 2000. Most of the publications are either of the type “article” or “case study”. The largest number of documents published concerned CD in conjunction with cardiomyopathy (33 studies), and there have also been substantial numbers of studies published on CD and thrombosis (27), cardiovascular risk (17), atherosclerosis (13), stroke (12), arterial function (11), and ischemic heart disease (11). Based on the published research, it can be concluded that many types of cardiovascular issues can occur in untreated CD patients, but that most tend to resolve on a GFD, often in conjunction with the healing of small intestinal villous atrophy. However, in some cases the alterations are irreversible, underscoring the need for CD screening and treatment when cardiovascular issues arise of unknown etiology.

Phenome‐wide association study in adult coeliac disease: role of HLA subtype

“…As Phe‐codes do not perfectly match ICD‐10 codes, we confirmed our observations by focusing on major common, potentially lethal disorders, defined by ICD‐10 codes. In line with the previous reports, 3,8 a variety of cardiovascular, respiratory and malignant ICD‐10 diagnoses were overrepresented in coeliac disease patients compared to controls (Figure 2). Individuals with coeliac disease more frequently displayed atherosclerosis (OR 1.9 [1.1‐3.6]), congestive heart failure (OR 2.1 [1.7‐2.6]), ischaemic heart disease (OR 1.84 [1.34‐1.58]) as well as pneumonia (OR 1.6 [1.3‐1.9]), chronic airway obstruction (OR 2.8 [2.1‐3.7]) and pulmonary collapse (OR 2.4 [2.1‐2.7]), (Figure 2A,B).…”

“…Coeliac disease constitutes an immune‐mediated enteropathy arising in genetically susceptible individuals in response to dietary gluten 1 . The complex interaction between consumption of gluten and environmental, genetic and immune factors results in a wide range of comorbidities from autoimmune, psychiatric 2 to cardiovascular diseases 3 and multiple neoplasms 4 . Moreover, the resulting small intestinal injury predisposes the patients to malabsorption, iron‐deficiency anaemia and osteoporosis 5‐7 .…”

Celiac Male’s Gluten-Free Diet Profile: Comparison to that of the Control Population and Celiac Women

“…The celiac population has been associated with an increased cardiovascular risk [ 39 , 40 ]. Although factors influencing the association between CD and cardiovascular disease could be related to the pathophysiology of CD, there is no doubt that the body composition and dietary pattern of celiac men described, with high intake of deleterious components, such as SFA, and low intake of protective ones, such as fiber, play an essential role.…”

Hematologic Manifestations in Celiac Disease—A Practical Review

“…With respect to thrombotic events, they can also be the prime manifestation of CD. Most cases report on venous thrombosis (deep venous thrombosis, pulmonary embolism, cerebral venous thrombosis, intraabdominal thrombosis), while arterial events have been rarely described [12,47,48,49,50]. In addition to case reports, an increased risk of venous thromboembolism has been shown in large cohort studies [51].…”