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Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden.

Abstract

BACKGROUND

Earlier studies on stroke in celiac disease (CD) have been underpowered, but a recent study suggested that childhood CD is associated with a 10-fold increased risk of death from stroke, although it was based on small numbers. We examined the risk of stroke in patients with biopsy-verified CD.

METHODS

We collected biopsy data from all 28 pathology departments in Sweden and identified 28,676 individuals with CD diagnosed between 1969 and 2007 (Marsh 3: villous atrophy). In the main analyses, we used Cox regression to estimate hazard ratios (HRs) for stroke in patients with CD compared with HRs for stroke in 141,806 sex- and age-matched controls.

RESULTS

During follow-up, there were 785 first-stroke diagnoses in patients with CD and 2937 in reference individuals. Patients with CD were at increased risk of stroke (HR 1.10; 95% confidence interval [CI] 1.01-1.19). HRs were similar for ischemic stroke and brain hemorrhage and were not affected by adjustment for type 1 diabetes, rheumatoid arthritis, use of medication against hypertension, or dyslipidemia. The absolute risk of stroke in patients with CD was 267 per 100,000 person-years (excess risk 24/100,000). The highest risk estimates occurred in the first year, with virtually no increased risk after more than 5 years of follow-up after CD diagnosis. The HR for stroke in childhood CD was 1.10 (95% CI 0.37-3.22).

CONCLUSIONS

Patients with CD are at only a small increased risk of stroke, which persists only for a brief period after diagnosis. CD does not seem to be a major risk factor for stroke.

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  • Authors+Show Affiliations

    ,

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

    , ,

    Source

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Biopsy
    Brain Ischemia
    Case-Control Studies
    Celiac Disease
    Child
    Child, Preschool
    Comorbidity
    Female
    Follow-Up Studies
    Humans
    Infant
    Infant, Newborn
    Intracranial Hemorrhages
    Male
    Middle Aged
    Prognosis
    Proportional Hazards Models
    Registries
    Risk Assessment
    Risk Factors
    Stroke
    Sweden
    Time Factors
    Young Adult

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    21733721

    Citation

    Ludvigsson, Jonas F., et al. "Risk of Stroke in 28,000 Patients With Celiac Disease: a Nationwide Cohort Study in Sweden." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 21, no. 8, 2012, pp. 860-7.
    Ludvigsson JF, West J, Card T, et al. Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden. J Stroke Cerebrovasc Dis. 2012;21(8):860-7.
    Ludvigsson, J. F., West, J., Card, T., & Appelros, P. (2012). Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 21(8), pp. 860-7. doi:10.1016/j.jstrokecerebrovasdis.2011.05.008.
    Ludvigsson JF, et al. Risk of Stroke in 28,000 Patients With Celiac Disease: a Nationwide Cohort Study in Sweden. J Stroke Cerebrovasc Dis. 2012;21(8):860-7. PubMed PMID: 21733721.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden. AU - Ludvigsson,Jonas F, AU - West,Joe, AU - Card,Tim, AU - Appelros,Peter, Y1 - 2011/07/05/ PY - 2010/12/02/received PY - 2011/05/07/revised PY - 2011/05/07/accepted PY - 2011/7/8/entrez PY - 2011/7/8/pubmed PY - 2013/4/24/medline SP - 860 EP - 7 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 21 IS - 8 N2 - BACKGROUND: Earlier studies on stroke in celiac disease (CD) have been underpowered, but a recent study suggested that childhood CD is associated with a 10-fold increased risk of death from stroke, although it was based on small numbers. We examined the risk of stroke in patients with biopsy-verified CD. METHODS: We collected biopsy data from all 28 pathology departments in Sweden and identified 28,676 individuals with CD diagnosed between 1969 and 2007 (Marsh 3: villous atrophy). In the main analyses, we used Cox regression to estimate hazard ratios (HRs) for stroke in patients with CD compared with HRs for stroke in 141,806 sex- and age-matched controls. RESULTS: During follow-up, there were 785 first-stroke diagnoses in patients with CD and 2937 in reference individuals. Patients with CD were at increased risk of stroke (HR 1.10; 95% confidence interval [CI] 1.01-1.19). HRs were similar for ischemic stroke and brain hemorrhage and were not affected by adjustment for type 1 diabetes, rheumatoid arthritis, use of medication against hypertension, or dyslipidemia. The absolute risk of stroke in patients with CD was 267 per 100,000 person-years (excess risk 24/100,000). The highest risk estimates occurred in the first year, with virtually no increased risk after more than 5 years of follow-up after CD diagnosis. The HR for stroke in childhood CD was 1.10 (95% CI 0.37-3.22). CONCLUSIONS: Patients with CD are at only a small increased risk of stroke, which persists only for a brief period after diagnosis. CD does not seem to be a major risk factor for stroke. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/21733721/Risk_of_stroke_in_28000_patients_with_celiac_disease:_a_nationwide_cohort_study_in_Sweden_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(11)00115-7 DB - PRIME DP - Unbound Medicine ER -