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Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease.

Abstract

BACKGROUND

Studies on ischemic heart disease (IHD) incidence in individuals with celiac disease (CD) are contradictory and do not take small intestinal pathology into account.

METHODS AND RESULTS

In this Swedish population-based cohort study, we examined the risk of IHD in patients with CD based on small intestinal histopathology. We defined IHD as death or incident disease in myocardial infarction or angina pectoris in Swedish national registers. In 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy; Marsh 3; n=28 190 unique individuals) and inflammation without villous atrophy (Marsh 1 to 2; n=12 598) from all 28 pathology departments in Sweden. A third cohort consisted of 3658 individuals with normal mucosa but positive CD serology (Marsh 0, latent CD). We found an increased risk of incident IHD in patients undergoing small intestinal biopsy that was independent of small intestinal histopathology (CD: hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.11 to 1.28; 991 events; inflammation: HR, 1.28; 95% CI, 1.19 to 1.39; 809 events; and latent CD: HR, 1.14; 95% CI, 0.87 to 1.50; 62 events). Celiac disease (HR, 1.22; 95% CI, 1.06 to 1.40) and inflammation (HR, 1.32; 95% CI, 1.14 to 1.52) were both associated with death resulting from IHD, whereas latent CD was not (HR, 0.71; 95% CI, 0.34 to 1.50).

CONCLUSIONS

Individuals with CD or small intestinal inflammation are at increased risk of incident IHD. We were unable to show a positive association between latent CD and incident IHD.

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  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden. jonasludvigsson@yahoo.com

    , , ,

    Source

    Circulation 123:5 2011 Feb 08 pg 483-90

    MeSH

    Adolescent
    Adult
    Age Distribution
    Aged
    Aged, 80 and over
    Celiac Disease
    Child
    Child, Preschool
    Cohort Studies
    Female
    Humans
    Infant
    Infant, Newborn
    Inflammation
    Male
    Middle Aged
    Morbidity
    Myocardial Ischemia
    Risk
    Sweden
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    21262996

    Citation

    Ludvigsson, Jonas F., et al. "Nationwide Cohort Study of Risk of Ischemic Heart Disease in Patients With Celiac Disease." Circulation, vol. 123, no. 5, 2011, pp. 483-90.
    Ludvigsson JF, James S, Askling J, et al. Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation. 2011;123(5):483-90.
    Ludvigsson, J. F., James, S., Askling, J., Stenestrand, U., & Ingelsson, E. (2011). Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation, 123(5), pp. 483-90. doi:10.1161/CIRCULATIONAHA.110.965624.
    Ludvigsson JF, et al. Nationwide Cohort Study of Risk of Ischemic Heart Disease in Patients With Celiac Disease. Circulation. 2011 Feb 8;123(5):483-90. PubMed PMID: 21262996.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. AU - Ludvigsson,Jonas F, AU - James,Stefan, AU - Askling,Johan, AU - Stenestrand,Ulf, AU - Ingelsson,Erik, Y1 - 2011/01/24/ PY - 2011/1/26/entrez PY - 2011/1/26/pubmed PY - 2011/4/8/medline SP - 483 EP - 90 JF - Circulation JO - Circulation VL - 123 IS - 5 N2 - BACKGROUND: Studies on ischemic heart disease (IHD) incidence in individuals with celiac disease (CD) are contradictory and do not take small intestinal pathology into account. METHODS AND RESULTS: In this Swedish population-based cohort study, we examined the risk of IHD in patients with CD based on small intestinal histopathology. We defined IHD as death or incident disease in myocardial infarction or angina pectoris in Swedish national registers. In 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy; Marsh 3; n=28 190 unique individuals) and inflammation without villous atrophy (Marsh 1 to 2; n=12 598) from all 28 pathology departments in Sweden. A third cohort consisted of 3658 individuals with normal mucosa but positive CD serology (Marsh 0, latent CD). We found an increased risk of incident IHD in patients undergoing small intestinal biopsy that was independent of small intestinal histopathology (CD: hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.11 to 1.28; 991 events; inflammation: HR, 1.28; 95% CI, 1.19 to 1.39; 809 events; and latent CD: HR, 1.14; 95% CI, 0.87 to 1.50; 62 events). Celiac disease (HR, 1.22; 95% CI, 1.06 to 1.40) and inflammation (HR, 1.32; 95% CI, 1.14 to 1.52) were both associated with death resulting from IHD, whereas latent CD was not (HR, 0.71; 95% CI, 0.34 to 1.50). CONCLUSIONS: Individuals with CD or small intestinal inflammation are at increased risk of incident IHD. We were unable to show a positive association between latent CD and incident IHD. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/21262996/Nationwide_cohort_study_of_risk_of_ischemic_heart_disease_in_patients_with_celiac_disease_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.110.965624?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -