Celiac Disease and Risk of Atrial Fibrillation: A Meta-analysis and Systematic Review

Abstract

IntroductionSeveral studies have found celiac disease may be associated with a variety of cardiac manifestations. Atrial fibrillation (AF) is one of the most common arrhythmias that can cause significant morbidity. However, the risk of atrial fibrillation in patients with celiac disease according to epidemiological studies remains unclear. The aim of this meta-analysis study is to assess the risk of atrial fibrillation in patients diagnosed with celiac disease compared to controls. MethodsA systematic literature review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated the risk of atrial fibrillation in patients with celiac disease. We included randomized controlled trial, cross sectional and cohort studies that reported the odds ratio, relative risk, hazard ratio, and standardized incidence ratio comparing the risk of developing atrial fibrillation among patients with celiac disease, versus patients without celiac disease as control. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. ResultsCeliac disease is an autoimmune condition. This inflammatory state predisposes patients to develop AF. After a review of the literature, four observational studies with a total of 64,397 participants were enrolled. The association between celiac disease and increased risk of atrial fibrillation was significant, with a pooled OR of 1.38 (95% CI: 1.01-1.88). No publication bias as assessed by the funnel plots and Egger's regression asymmetry test with p = 0.54. However, the heterogeneity of the included studies was high (I2 = 96). ConclusionA significant association between celiac disease and risk of atrial fibrillation was reported in this study. There is a 38% increased risk of atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and celiac disease. Some of the limitations of this study are that all were observational studies, some were medical registry-based and there was high heterogeneity between studies.

Celiac disease presenting as abnormal atrial rhythm resolving after gluten-free diet

“…During recent decade growing number of publications describe an association of various cardiovascular diseases with CD, including increased vascular thrombosis, cardiomyopathy, myocarditis, pericardial effusion, accelerated atherosclerosis, and rhythm disturbances [1][2][3][4] . Moreover, cardiovascular disease was suggested to be the leading cause of death of CD patients [3] .…”

Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis

“…Adjusted point estimates and standard errors from the individual studies were combined using the generic inverse variance method of DerSimonian and Laird, which assigned the weight of each study based on its variance [16]. In light of the possible high between-study variance due to different study designs and populations, we used a random-effect model rather than a fixed-effect model [15]. Cochran's Q test and I2 statistic were used to determine the between-study heterogeneity.…”

“…The Newcastle-Ottawa scale (Figure 1 ) was used by the investigators independently to determine the quality of each study. This scale evaluates each study in terms of participants selection (minimum score is 0; maximum is 4), comparability (minimum score is 0; maximum is 2), and the ascertainment of the exposure of interest for case-control studies, and the outcome of interest for cohort studies (minimum score is 0; maximum is 3) [ 13 , 14 , 15 ]. Newcastle-Ottawa scale contains eight items within three domains and the total maximum score is 9.…”

“…Cochran's Q test and I2 statistic were used to determine the between-study heterogeneity. A value of I2 of 0%-25% represents insignificant heterogeneity, greater than 25% but less than or equal to 50% represents low heterogeneity, greater than 50% but less than or equal to 75% represents moderate heterogeneity, and greater than 75% represents high heterogeneity [ 14 , 15 ].…”

Atrioventricular Block in Celiac Disease: An Unusual Clinical Presentation in a Child. A Case-Based Review

“…Cardiac involvement (either idiopathic or immunological) has also been described in untreated adults or young adult patients with CeD [ 8 ]. Dilated cardiomyopathy, myocarditis [ 9 ], atrial fibrillation [ 10 ], and atherosclerosis with an increased risk of ischemic heart disease [ 11 ] are the most common manifestations that are reported in the literature.…”