The Characterisation and Risk Factors of Ischaemic Heart Disease in Patients With Coeliac Disease

L. Emilsson; R. Carlsson; M. Holmqvist; S. James; J. F. Ludvigsson


Aliment Pharmacol Ther. 2013;37(9):905-914. 

In This Article

Abstract and Introduction


Background Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.

Aim To characterise IHD according to CD status.

Methods Data on duodenal or jejunal biopsies were collected in 2006–2008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.

Results We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P < 0.001) and cholesterol values (P < 0.001) and were less likely to be active smokers (OR = 0.74; 95% CI = 0.56–0.98) than reference individuals with myocardial infarction. CD patients had less extensive coronary artery disease at angiography (any stenosis: OR = 0.80; 95% CI = 0.66–0.97; three-vessel disease: OR = 0.73; 95% CI = 0.57–0.94); but there was no difference in the proportions of CD patients with positive biochemical markers of myocardial infarction (CD: 92.2% vs. reference individuals: 91.5%,P = 0.766).

Conclusion Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.


Coeliac disease (CD) occurs in about 1% in the European and North American population.[1] Cardiovascular disease is one of the leading causes of death in CD.[2] Several studies have reported statistically significant increased risks of ischaemic heart disease (IHD) (incident or death) in CD,[2–4] whereas two British studies suggested nonsignificant negative associations with IHD.[5, 6] The increased risk of IHD in CD cannot be fully explained by traditional cardiovascular risk factors because CD patients have a lower average body mass index (BMI),[7] less often suffer from hypertension (HT),[6] and in some studies are reported to be less likely to be daily smokers[8] (while smoking is not associated with CD in other populations[9,10]). To our knowledge, no study has examined the prevalence of traditional cardiovascular risk factors or clinical presentation and phenotype of IHD in CD patients and general population reference individuals. The aim of this nationwide population-based study was therefore to characterise the risk-factor profiles and phenotype of IHD in CD.