Coeliac and cardiovascular disease: a possible relationship between two apparently separate conditions

Submitted: July 5, 2022
Accepted: July 17, 2022
Published: July 20, 2022
Abstract Views: 1165
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Coeliac disease (CD) is an autoimmune condition with a high prevalence among general population and multisystemic involvement: a more complex scene than a merely gastrointestinal disease. Therefore, an early diagnosis and treatment with a gluten-free diet is mainly important to reduce mortality and comorbidities. Together with autoimmune diseases (as Hashimoto thyroiditis, insulin-dependent diabetes mellitus, autoimmune liver disease and connective tissue diseases), also an accelerated progression of atherosclerosis and a higher prevalence of heart disease have been reported in coeliacs. In the present paper we tried to collect from literature the emergent data on the probable relationship between coeliac and cardiovascular disease, focusing on pathophysiological bases of vascular injury. Data and opinions on the development of cardiovascular risk in patients with CD are conflicting. However, the major evidence supports the theory of an increased cardiovascular risk in CD, due to many mechanisms of myocardial injury, such as chronic malabsorption, abnormalities of intestinal permeability, and direct immune response against self-proteins. The conclusions that come from these data suggest the utility of a careful cardiovascular follow up in coeliac patients.

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Tommasini A, Not T, Kiren V, Baldas V, et al. Mass screening For coeliac disease using Antihuman transglutaminase Antibody assay. Arch Dis Child 2004;89:512-5. DOI: https://doi.org/10.1136/adc.2003.029603
Green P, Cellier C. Celiac disease. N Engl J Med 2007;357:1731-43. DOI: https://doi.org/10.1056/NEJMra071600
Corrao G, Corazza GR, Bagnardi V, et al; Club del Tenue Study Group. Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet 2001;358:356-61. DOI: https://doi.org/10.1016/S0140-6736(01)05554-4
Koning F. Celiac disease: caught between a rock and hardplace. Gastroenterology 2005;129:1294-301. DOI: https://doi.org/10.1053/j.gastro.2005.07.030
Chicco D, Taddio A, Sinagra G, et al. Speeding up coeliac disease diagnosis in cardiological settings. Arch Med Sci 2010; 6,5:728-32. DOI: https://doi.org/10.5114/aoms.2010.17088
Fasano A. Systemic autoimmune disorders in celiac disease. Curr Opin Gastroenterol 2006;22:674-9. DOI: https://doi.org/10.1097/01.mog.0000245543.72537.9e
Frustaci A, Cuoco L, Chimenti C, et al. Celiac disease associated with autoimmune myocarditis. Circulation 2002;105:2611-8. DOI: https://doi.org/10.1161/01.CIR.0000017880.86166.87
Curione M, Barbato M, Viola F, Francia P, De Biase L, Cucchiara S. Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance. Dig Liver Dis 2002;34:866-9. DOI: https://doi.org/10.1016/S1590-8658(02)80258-4
Vizzardi E, Lanzarotto F, Carabellese N, et al. Lack of association of coeliac disease with idiopathic and ischaemic dilated cardiomyopathies. Scand J Clin Lab Invest 2008;68:692-5. DOI: https://doi.org/10.1080/00365510802085370
Not T, Faleschini E, Tommasini A, et al. Celiac disease in patients with sporadic and inherited cardiomyopathies and in their relatives. Eur Heart J 2003;24:1455-61. DOI: https://doi.org/10.1016/S0195-668X(03)00310-5
DeMeo MT, Mutlu EA, Keshavarzian A, Tobin MC. Intestinal permeation and gastrointestinal disease. J Clin Gastroenterol 2002;34:385-96. DOI: https://doi.org/10.1097/00004836-200204000-00003
Chimenti C, Pieroni M, Maseri A. Dilated cardiomyopathy and celiac disease. Ital Heart J 2002;3:385.
Sciatti E, Orabona R. A window of opportunity on cardiovascular prevention: pre-eclampsia and fetal growth restriction. Eur J Prev Cardiol 2022;28:e17-8. DOI: https://doi.org/10.1177/2047487320925646
Cavazzana I, Piantoni S, Sciatti E, et al. Relationship between endothelial dysfunction, videocapillaroscopy and circulating CD3+CD31+CXCR4+ lymphocytes in systemic lupus erythematosus without cardiovascular risk factors. Lupus 2019;28:210-6. DOI: https://doi.org/10.1177/0961203318821161
Gorga E, Scodro M, Valentini F, et al. Echocardiographic evaluation of diastolic dysfunction in young and healthy patients with psoriasis: A case-control study. Monaldi Arch Chest Dis 2018;88:934. DOI: https://doi.org/10.4081/monaldi.2018.934
Malerba M, Radaeli A, Nardin M, et al. Endothelial dysfunction assessment by noninvasive peripheral arterial tonometry in patients with chronic obstructive pulmonary disease compared with healthy subjects. Clin Respir J 2018;12:1466-72. DOI: https://doi.org/10.1111/crj.12686
Vizzardi E, Sciatti E, Bonadei I, et al. Subclinical cardiac involvement in Crohn's disease and ulcerative colitis: an echocardiographic case-control study. Panminerva Med 2016;58:115-20.
Sciatti E, Orabona R. A still-ignored cardiovascular risk factor-A history of preeclampsia. JAMA Cardiol 2021;6:1097-8. DOI: https://doi.org/10.1001/jamacardio.2021.1958
Makhdoom ZA, Randall NW. Dilated cardiomyopathy due to anticardiolipin syndrome in association with celiac sprue. J Clin Gastroenterol 2000;31:91-2. DOI: https://doi.org/10.1097/00004836-200007000-00024
Ludvigsson JF, Montgomery SM. Small intestinal histopathology and mortality risk in celiac disease. JAMA 2009;302:1171-8. DOI: https://doi.org/10.1001/jama.2009.1320
Ludvigsson JF. Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation 2011;123:483-90. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.965624
West J, Logan RF, Card TR, Smith C, Hubbard R. Risk of vascular disease in adults with diagnosed celiac disease: a population-based study. Aliment Pharmacol Ther 2004;20:73-9. DOI: https://doi.org/10.1111/j.1365-2036.2004.02008.x
Whorwell PJ. Death from ischaemic heart disease and malignancy in adult patients with coeliac disease. Lancet 1976;2:113-4. DOI: https://doi.org/10.1016/S0140-6736(76)92843-9
Snook JA. Adult coeliac disease and cigarette smoking. Gut 1996;39:60-2. DOI: https://doi.org/10.1136/gut.39.1.60
Emilsson L. The characterization and risk factors of ischemic heart disease in patients with coeliac disease. Aliment Pharmacol Ther 2013;37:905-14. DOI: https://doi.org/10.1111/apt.12271
Brar P, Kwon GY, Holleran S, et al. Change in lipid profile in celiac disease: beneficial effect of a gluten-free diet. Am J Med 2006;119:786-90. DOI: https://doi.org/10.1016/j.amjmed.2005.12.025
Hallert C, Grant C, Grehn S, et al. Evidence of poor vitamin status in celiac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther 2006;16:1333-9. DOI: https://doi.org/10.1046/j.1365-2036.2002.01283.x
De Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther 2013;38:162-9. DOI: https://doi.org/10.1111/apt.12360
Simons PC, Algra A, Bots ML, Grobbee DE, van der Graaf Y. Common carotid intima-media thickness and arterial stiffness: indicator of cardiovascular risk in high-risk patients. The SMART Study. Circulation 1999;100:951-7. DOI: https://doi.org/10.1161/01.CIR.100.9.951
Viljama M, Kaurinen K, Pukkala E. Malignancies and mortality in patients with coeliac disease and dermatitis herpetiformis: a 30-year population-based study. Dig Liv Dis 2006;38:374-80. DOI: https://doi.org/10.1016/j.dld.2006.03.002
Szucs G, Tímár O, Szekanecz Z, et al. Endothelial dysfunction precedes atherosclerosis in systemic sclerosis relevance for prevention of vascular complication. Rheumatology 2007;46:759-62. DOI: https://doi.org/10.1093/rheumatology/kel426
Tugcin B, Nafiye U, Yalim Y, et al. Cardiac functions in children with coeliac disease during follow-up: Insights from tissue Doppler imaging. Dig Liver Dis 2008;40:182-7. DOI: https://doi.org/10.1016/j.dld.2007.11.014
Henry WL, Bonow RO, Rosing DR, Epstein SE. Observation on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic Evaluation of asymptomatic patients. Circulation 1980;61:484-92. DOI: https://doi.org/10.1161/01.CIR.61.3.484
Waggoner AD, Bierig SM. Tissue Doppler imaging: a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function. J Am Soc Echocardiogr 2001;14:1143-52. DOI: https://doi.org/10.1067/mje.2001.115391
West J, Logan RF. Fractures risk in people with celiac disease: a population-based cohort study. Gastroenterology 2003;125:429-36. DOI: https://doi.org/10.1016/S0016-5085(03)00891-6
Heikkilä K, Koskinen OA, Agarwal A, et al. Associations of coeliac disease with coronary heart disease and cerebrovascular disease: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2015;25:816-31. DOI: https://doi.org/10.1016/j.numecd.2015.05.004
Peters U, Askling J, Gridley G, et al. Causes of death in patients with celiac disease in a population based Swedish cohort. Arch Intern Med 2003;163:1566-72. DOI: https://doi.org/10.1001/archinte.163.13.1566
Wei L, Spiers E, Reynolds N, et al. Association between celiac disease and cardiovascular disease. Aliment Pharmacol Ther 2008;27:514-9. DOI: https://doi.org/10.1111/j.1365-2036.2007.03594.x
Dickey W. Overweight in celiac disease: prevalence, clinical characteristics, and effect of gluten-free diet. Am J Gastroenterol 2006;101:2356-9. DOI: https://doi.org/10.1111/j.1572-0241.2006.00750.x
Wild D. Evidence of high sugar intake, and low fibrate and mineral intake, in the gluten free diet. Aliment Pharmacol Ther 2010;32:573-81. DOI: https://doi.org/10.1111/j.1365-2036.2010.04386.x
Kim HS, Patel KG. Time trends in the prevalence of celiac disease and gluten free diet in the US population: results from the National Health and Nutrition Examination Surveys 2009-2014. JAMA Intern Med 2016;176:1716-7. DOI: https://doi.org/10.1001/jamainternmed.2016.5254
Sciatti E, Bernardi N, Dallapellegrina L, et al. Evaluation of systo-diastolic cardiac function and arterial stiffness in subjects with new diagnosis of coeliac disease without cardiovascular risk factors. Intern Emerg Med 2020;15:981-8. DOI: https://doi.org/10.1007/s11739-019-02261-7
Emilsson L, Andersson B, Elfström P, et al. Risk of idiopathic dilated cardiomyopathy in 29 000 patients with celiac disease. J Am Heart Assoc 2012;1:e001594. DOI: https://doi.org/10.1161/JAHA.112.001594
Lebwohl B, Cao Y, Zong G, et al. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ 2017;375:j1892. DOI: https://doi.org/10.1136/bmj.j1892

How to Cite

Bernardi, Nicola, Edoardo Sciatti, Edoardo Pancaldi, Fabio Alghisi, Andrea Drera, Raffaele Falco, and Enrico Vizzardi. 2022. “Coeliac and Cardiovascular Disease: A Possible Relationship Between Two Apparently Separate Conditions”. Monaldi Archives for Chest Disease 93 (2). https://doi.org/10.4081/monaldi.2022.2366.