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Follow-up of ischaemic heart disease in patients with coeliac disease
Örebro University, School of Medicine, Örebro University, Sweden. Vårdcentralen Värmlands Nysäter, Värmlands Nysäter, Sweden.
PCI unit, Department of Cardiology, Central Hospital, Karlstad, Sweden .
Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
Department of Cardiology and Clinical Research Centre, Falun Hospital, Falun, Sweden .
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2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 1, p. 83-90Article in journal (Refereed) Published
Abstract [en]

Patients with coeliac disease and myocardial infarction have a more favourable atherosclerotic risk factor profile than controls with myocardial infarction (MI). Therefore, MI prognosis and treatment may differ according to coeliac status. This paper reports on the study of Swedish MI patients with and without coeliac disease (equal to villous atrophy; Marsh histopathology stage 3) based on duodenal or jejunal biopsy data. We used the Swedish Quality Register (SWEDEHEART) to identify individuals with a record of MI from 2005 to 2008 and to obtain data on medication, coronary interventions, and clinical and laboratory parameters at 6–10 weeks and one year after first MI. One-year mortality and coronary interventions were assessed for 430 coeliac patients and 1988 controls. For other outcome variables, we compared 42 coeliac patients with MI and 201 general population controls with MI. Odds ratios (ORs) were calculated by logistic regression. The results showed that compared with controls with MI, coeliac individuals with MI had significantly higher one-year all-cause mortality (OR = 1.43; 95% confidence interval (CI) = 1.04–1.95) but less often underwent a percutaneous coronary intervention (OR = 0.77; 95% CI = 0.61–0.96). Coeliac patients were more often prescribed warfarin but less often aspirin and statins. The readmission rate due to cardiac events in coeliac patients was 15.2% vs. 12.6% in controls (p-value  = 0.69). Other clinical and laboratory parameters were similar. We conclude that the follow up of MI does not seem to differ between coeliac patients and controls, and is unlikely to explain the excess mortality from cardiovascular disease noted in Swedish patients with CD.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2015. Vol. 22, no 1, p. 83-90
Keywords [en]
Autoimmunity, coeliac, inflammation, riskfactors, myocardialinfarction
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-32523DOI: 10.1177/2047487313502446ISI: 000346557500007PubMedID: 23963400Scopus ID: 2-s2.0-84918493520OAI: oai:DiVA.org:oru-32523DiVA, id: diva2:666923
Funder
Swedish Research Council, 522-2A09-195
Note

Funding Agencies:

Swedish Society of Medicine

Swedish Celiac Society

Värmland County

Available from: 2013-11-25 Created: 2013-11-25 Last updated: 2018-06-26Bibliographically 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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