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The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Vårdcentralen Värmlands Nysäter, Värmland County, Sweden.
PCI unit, Department of Cardiology, Central Hospital, Karlstad, Sweden.
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Sweden.
Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
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2013 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 37, no 9, p. 905-914Article in journal (Refereed) Published
Abstract [en]

Background: Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.

Aim: To characterise IHD according to CD status.

Methods: Data on duodenal or jejunal biopsies were collected in 20062008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.

Results: We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P<0.001) and cholesterol values (P<0.001) and were less likely to be active smokers (OR=0.74; 95% CI=0.560.98) than reference individuals with myocardial infarction. CD patients had less extensive coronary artery disease at angiography (any stenosis: OR=0.80; 95% CI=0.660.97; three-vessel disease: OR=0.73; 95% CI=0.570.94); but there was no difference in the proportions of CD patients with positive biochemical markers of myocardial infarction (CD: 92.2% vs. reference individuals: 91.5%, P=0.766).

Conclusion: Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.

Place, publisher, year, edition, pages
2013. Vol. 37, no 9, p. 905-914
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-29001DOI: 10.1111/apt.12271ISI: 000317065600006PubMedID: 23451861OAI: oai:DiVA.org:oru-29001DiVA, id: diva2:621237
Available from: 2013-05-14 Created: 2013-05-13 Last updated: 2018-05-17Bibliographically approved
In thesis
1. Cardiac complications in celiac disease
Open this publication in new window or tab >>Cardiac complications in celiac disease
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Celiac disease (CD) is an immune-mediated enteropathy induced by dietary gluten that affects about 1% of western populations. CD has been associated to an increased risk of cardiovascular mortality in some studies; however associations to cardiovascular diseases have not been broadly researched.

Aim: The aim of this thesis was to examine the associations between CD and some cardiovascular diseases, namely; atrial fibrialltion, dilated cardiomyopathy and risk factors of ischemic heart disease.Methods: We used computerized data on all Swedish patients with biopsy-verified CD equal to villous atrophy from 1969 to 31st of December 2008. All CD patients were matched on age, sex, county and calendar year with up to five reference individuals. Altogether we had data on 29,096 CD patients and 144,522 reference individuals. Data were linked to different Swedish national registries and the Swedish quality and cardiac care registry SWEDEHEART. Main outcomes in the studies were: I: atrial fibrillation registered in the national patient registry or the cause of death registry, II: chart validated idiopathic dilated cardiomyopathy, III: different risk factors, clinical presentation and parameters in patients with first myocardial infarction (MI) registered in SWEDEHEART and IV: follow-up parameters, 6-10 weeks and one year after MI, registered in SWEDEHEART.

Result: We showed a 34% increased risk of atrial fibrillation in CD and a 73% increased risk of dilated cardiomyopathy, the latter only of borderline significance, p=0.052. In the third study we showed that CD patients with MI had a more beneficial cardiovascular risk factor profile, better left ventricular ejection fraction and fewer stenoses on coronary angiography compared to reference individuals with MI. The fourth study showed that follow-up after MI does not differ from follow-up in reference individuals.

Conclusion: This thesis supports an association of cardiovascular diseases in CD. Potential mechanisms include shared risk factors and chronic in-flammation.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 82
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 92
Keywords
atrial fibrillation, autoimmune, celiac disease, cohort, dilated cardiomyopathy, inflammation, myocardial infarction, registry
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-28977 (URN)978-91-7668-955-4 (ISBN)
Public defence
2013-10-11, Wilandersalen, Universitetssjukhuset, Södra Grev Rosengatan, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2013-05-06 Created: 2013-05-06 Last updated: 2017-10-17Bibliographically approved

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Emilsson, LouiseLudvigsson, Jonas F.

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