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Mucosal healing and the risk of ischemic heart disease or atrial fibrillation in patients with celiac disease: a population-based study
Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New YorkNY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
Primary care research unit, Vårdcentralen Värmlands Nysäter, Värmland County, Karlstad, Sweden; Department of Medicine, Örebro University, Örebro, Sweden.
Örebro University Hospital. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, USA;-Presbyterian Hospital, New York, USA.
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 1, article id e0117529Article in journal (Refereed) Published
Abstract [en]

Background: Patients with celiac disease (CD), characterized histologically by villous atrophy (VA) of the small intestine, have an increased risk of ischemic heart disease (IHD) and atrial fibrillation (AF), risks that persist for years after commencing the gluten-free diet. It is unknown whether persistent VA on follow-up biopsy, rather than mucosal healing, affects the risk of IHD or AF.

Methods: We identified patients with histologic evidence of CD diagnosed at all 28 pathology departments in Sweden. Among patients who underwent a follow-up small intestinal biopsy, we compared patients with persistent VA to those who showed histologic improvement, with regard to the development of IHD (angina pectoris or myocardial infarction) or AF.

Results: Among patients with CD and a follow-up biopsy (n = 7,440), the median age at follow-up biopsy was 25 years, with 1,063 (14%) patients who were >= 60 years at the time of follow-up biopsy. Some 196 patients developed IHD and 205 patients developed AF. After adjusting for age, gender, duration of CD, calendar period, and educational attainment, there was no significant effect of persistent VA on IHD (adjusted HR 0.97; 95%CI 0.73-1.30). Adjusting for diabetes had a negligible effect (adjusted HR 0.98; 95%CI 0.73-1.31). There was no significant association between persistent VA and the risk of AF (adjusted HR 0.98; 95%CI 0.74-1.30).

Conclusions: In this population-based study of patients with CD, persistent VA on follow-up biopsy was not associated with an increased risk of IHD or AF. Failed mucosal healing does not influence the risk of these cardiac events.

Place, publisher, year, edition, pages
2015. Vol. 10, no 1, article id e0117529
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-44242DOI: 10.1371/journal.pone.0117529ISI: 000350680700090OAI: oai:DiVA.org:oru-44242DiVA, id: diva2:804968
Note

Funding Agencies:

National Center for Advancing Translational Sciences, National Institutes of Health UL1 TR000040

Örebro University Hospital

Swedish Society of Medicine

Swedish Research Council-Medicine 522-2A09-195

Swedish Celiac Society

Karolinska Institutet

Available from: 2015-04-14 Created: 2015-04-14 Last updated: 2018-06-29Bibliographically approved

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Emilsson, LouiseFröbert, OleLudvigsson, Jonas F.

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