People with coeliac disease have a heightened risk of developing cardiovascular disease, despite having fewer known risk factors, a new study shows today.
Previous studies have not focused on the potential role of traditional cardiovascular risk factors, such as blood pressure or cholesterol, researchers say.
The study, led by researchers from Oxford Population Health, drew on medical data supplied by UK Biobank participants to try to establish if traditional cardiovascular risk factors might contribute to the link between coeliac disease and a heightened risk of cardiovascular disease.
Out of the half a million 40-69 year olds from England, Scotland, and Wales participating in the UK Biobank study, 2083 had coeliac disease but no cardiovascular disease, when recruited.
Their cardiovascular health was monitored, using linked hospital records and death certificates, for an average of just over 12 years.
Individuals with coeliac disease were more likely to be women at 71.5% compared with 56%without the condition and white (99% compared to 95% without the condition).
During the monitoring period, 40,687 were diagnosed with cardiovascular disease, of which 218 were in people with coeliac disease. This is equivalent to an annual rate of nine in every 1000 people, compared with an annual rate of 7.4/1000 in those without the condition.
Writing in *BMJ Medicine*, the researchers say this equates to a 27% increased risk of cardiovascular disease for people with coeliac disease compared with those who did not have it.
They found risk increased the longer a person had been living with their condition: a 30% increased risk in those who had had coeliac disease for less than 10 years, rising to an increased risk of 34% among those who had had it for 10 or more years.
However, those with coeliac disease had fewer of the known risk factors for cardiovascular disease, were likely to have a lower BMI and a lower systolic blood pressure, and were more likely to have a an ideal cardiovascular risk score than people with coeliac disease.
When the researchers analysed the potential joint effects of coeliac disease and cardiovascular risk score on incident cardiovascular disease, the risk increased by more than 60% in people with coeliac disease plus an ideal cardiovascular disease risk score compared with those with an ideal risk score but no coeliac disease.
Although this is an observational study, the authors say several autoimmune conditions are associated with a heightened risk of cardiovascular disease as a result of systemic inflammation.
“This study highlights the importance of cardiovascular disease as a potential complication of coeliac disease. Further research into the drivers and mechanistic pathways of this association is warranted,” they say.
“In addition, an investigation is warranted into the extent to which any risk reduction is reported by adherence to a gluten-free diet in people with coeliac disease, or whether a gluten-free diet itself contributes to the increased risk identified.
“Given the increased rates of cardiovascular disease reported in people with coeliac disease who have an ideal and moderate cardiovascular disease risk score, clinicians should make patients with coeliac disease aware of their elevated risk, and work with their patients to optimise their cardiovascular health.”
Conroy M, Allen N, Lacey B et al. Association between coeliac disease and cardiovascular disease: prospective analysis of UK Biobank data. *BMJ Medicine* 31 January 2023; doi 10.1136/bmjmed-2022-000371
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