Higher Risk of Heart Disease When You Have Celiac?

Risk of Coronary Artery Disease, A-Fib Raised

atherosclerosis
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When you think about celiac disease, you most likely think first of its effects on your digestive system. But the condition has a significant effect on another important system: your cardiovascular system.

Research shows that people with celiac disease have a higher risk of two different types of cardiovascular disease: ischemic heart disease (more commonly known as coronary artery disease), and atrial fibrillation (an irregular, usually rapid heart beat that's called A-Fib for short).

Celiacs also have an increased risk of dying from heart disease, although following the gluten-free diet appears to lessen that risk somewhat.

It's not clear why all this occurs, especially since those with celiac disease are less likely to be overweight or to smoke, two key risk factors for heart disease. They also tend to have lower cholesterol. Some researchers have speculated that inflammation driven by the immune system's reaction to gluten ingestion could be to blame, but studies haven't yet definitively proven that theory.

Nonetheless, the increased risk still exists. A 2008 study performed in Scotland that followed 367 people with celiac disease for an average of nearly four years after they were diagnosed found they had nearly twice the risk of people without the condition for so-called "cardiovascular events," including coronary artery disease, heart failure, stroke or heart attack.

Researchers believe you should pay close attention to this. Heart disease is the number one killer worldwide, and anything that increases your chances of having heart disease — including having celiac disease — is significant.

Here's what we know (and don't know) about celiac disease and your risk of heart disease, and what you can do to manage and lower your risk.

Celiacs Don't Have 'Traditional' Coronary Risk Factors

When you have coronary artery disease, a waxy substance called plaque builds up in the arteries that supply your heart muscle with blood. This plaque build-up can mean your heart muscle isn't getting the oxygen it needs to function well, which can cause chest pain, especially when you're active.

Ultimately, if enough plaque builds up, a piece of it can rupture, leading to a blood clot that can block the artery. This causes a heart attack.

Most people are familiar with the characteristics that place you at risk for coronary artery disease: being overweight, having high cholesterol, and smoking are three key risk factors.

However, people with celiac disease who develop coronary artery disease don't fit very well into that familiar picture. They tend to be thinner, have lower total cholesterol, and smoke less than those without celiac disease who also have coronary artery disease.

It's true that profile of the typical celiac is changing — people are increasingly overweight or even obese (not dangerously thin) when they're diagnosed, for example.

But that's not what's driving the increased risk of heart disease in celiacs.

Celiac Disease and Coronary Artery Disease: Inflammation the Link?

So what could cause this increased risk? Scientists speculate that it's due to what some call "a chronic inflammatory state." 

Inflammation appears to play a key role in the development of coronary artery disease, as it helps to jump-start plaque build-up in your arteries.

People with celiac disease (which is an autoimmune condition) have immune systems that have turned on their own tissues. This celiac-specific immune system response might in turn drive inflammation elsewhere in the body, including in the arteries that serve your heart. Recent scientific research on specific inflammation-driving cells produced by the immune system, and how those cells interact with plaques in arteries, seems to back this theory.

In fact, a 2013 study looked at adults just diagnosed with celiac disease and found they tended to have high levels of two markers of inflammation, plus test results indicating they had the beginnings of plaque build-up in their arteries. Some of these test results improved once the people had followed the gluten-free diet for six to eight months, indicating that overall inflammation had dropped.

Nonetheless, the researchers concluded that adults with celiac disease seem to be at high risk for early coronary artery disease, based on those markers of inflammation.

A-Fib: Another Potential Risk

Atrial fibrillation is an electrical problem with your heart that leads to an erratic, often fast heart rhythm. It's a chronic condition that can last for years, and it's most common in people older than 40. When you have A-Fib, it increases your risk of a stroke, blood clot, or heart failure.

People with celiac disease also suffer from higher rates of atrial fibrillation, although the extra risk appears to be small. In one study, conducted in Sweden, researchers looked for atrial fibrillation diagnoses in 28,637 people who already had been diagnosed with celiac disease.

They found 941 cases of A-Fib in that group over the nine years following their celiac diagnoses. Already having A-Fib also increased the risk of later being diagnosed with celiac disease.

Overall, having celiac disease made a person about 30% more likely to be diagnosed with A-Fib than someone who didn't have celiac disease, the study concluded. Again, inflammation may be to blame, the authors wrote: "This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation." They noted that additional studies are needed to determine exactly why A-Fib is more common in celiac disease and possibly in other autoimmune diseases.

Stroke Not as Big a Problem in Celiac

There's some good news when we look at the link between celiac disease and different types of cardiovascular disease: stroke doesn't seem to be as much of a problem.

Using the same large celiac disease patient database as the Swedish study on atrial fibrillation, researchers looked at the risk of stroke in those 28,637 patients, comparing the stroke risk to more than 141,806 similar people without celiac disease.

The study found that those with celiac disease had about a 10% higher risk of stroke overall, but most of their higher risk was concentrated in the first year after their celiac diagnoses. There was "virtually no increased risk after more than five years of follow-up after celiac disease diagnosis." Previous, smaller studies had found that those diagnosed with celiac disease during childhood had a much higher risk of stroke, but this larger study found only a very slightly increased risk. 

The authors concluded: "Patients with celiac disease are at only a small increased risk of stroke, which persists only for a brief period after diagnosis. Celiac disease does not seem to be a major risk factor for stroke."

Improving Your Heart Disease Odds

Okay, so having celiac disease does seem to increase your chances of having heart disease — which is pretty serious and potentially deadly. So what can you do about it?

First, don't smoke (and if you do smoke, quit). Smoking raises your risk of coronary artery disease significantly, and the chemicals in tobacco smoke can directly damage your heart.

Second, you should make sure you're at a normal weight. Being overweight or obese raises your odds of heart disease, regardless of whether or not you have celiac disease. While it can be tricky to lose weight when you're already following a restricted diet, many people with celiac disease fortunately find their weight tends to "normalize" when they first go gluten-free (in other words, if they're overweight they lose weight, and if they're underweight they tend to gain).

Of course, you may not be so lucky to effortlessly drop weight when you first go gluten-free (lots of people aren't). If you're struggling with your weight, take a look at these five tips for gluten-free weight loss success. These three best weight-loss programs when you're gluten-free also may help.

Next, you should consider talking to your doctor about whether you're at risk for metabolic syndrome, which is a name given by doctors for a group of risk factors for heart disease, diabetes and stroke.

It's not clear how having celiac disease affects your risk for metabolic syndrome — the studies on this have been mixed. But it's absolutely clear that having metabolic syndrome raises your risk for heart disease substantially. So if you have it, you should know about it, and talk to your doctor about how to address the problem.

Finally, you should pay attention to your vitamin intake. The gluten-free diet tends to lack in some vitamins that are crucial to heart and cardiovascular health, including folate, vitamin B6 and vitamin B12.

The Bottom Line

We don't know whether sticking strictly to the gluten-free diet (as opposed to cheating on the diet) will help with heart health — studies haven't addressed that question yet. (There are, of course, other good reasons not to cheat on the diet.) One study did find that the risk of coronary artery disease and atrial fibrillation wasn't affected by how much your small intestine has healed, though, so you can't ignore the possibility of heart disease just because you're strictly gluten-free.

Therefore, your best bet to avoid heart disease, even with a potentially increased risk because you have celiac disease, is to live a heart-healthy lifestyle: don't smoke, stay in a normal weight range, eat a healthy diet, and exercise.

Sources:

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Emilsson L et al. The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease. Alimentary Pharmacology & Therapeutics. 2013 May;37(9):905-14.

Lebwohl B et al. Mucosal healing and the risk of ischemic heart disease or atrial fibrillation in patients with celiac disease; a population-based study. PLoS One. 2015 Jan 30;10(1):e0117529.

Ludvigsson JF et al. Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden. Journal of Stroke and Cerebrovascular Diseases. 2012 Nov;21(8):860-7.

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