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  • 1.
    Emilsson, Louise
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Primary Care Res Unit, Värmlands Nysäter, Värmland County Council, Sweden.
    James, Stefan
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ischaemic heart disease in first-degree relatives to coeliac patients2014In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 44, no 4, p. 359-364Article in journal (Refereed)
    Abstract [en]

    Objective: Coeliac disease (CD) has been linked to an increased risk of ischaemic heart disease (IHD). We examined the risk of IHD in first-degree relatives and spouses to coeliac patients to ascertain the genetic contribution to IHD excess risk.

    Study design and setting: Coeliac disease was defined as having a biopsy-verified villous atrophy (Marsh grade 3) in 1969-2008 (n=29096). Coeliac patients were matched to 144522 controls. Through Swedish registers, we identified all first-degree relatives and spouses to coeliac patients and their controls, in total 87622 unique coeliac relatives and 432655 unique control relatives. Our main outcome measure was IHD defined according to relevant international classification of disease codes in the Swedish Inpatient Registry or in the Cause of Death Registry. Hazard ratios (HR) and confidence intervals (CI) were estimated through Cox regression adjusted for sex, age-group and calendar year at study entry of the relative.

    Result: During a median follow-up of 108 years, 2880 coeliac relatives and 13817 control relatives experienced IHD. First-degree relatives of coeliac patients were at increased risk of IHD (HR=105; 95% CI=100-109, P-value=004), while spouses were at no increased risk (HR=099; 95% CI=087-112). The excess risk of IHD in coeliac first-degree relatives aged 40-59years was 70/100000 person-years.

    Conclusion: First-degree relatives to coeliac patients seem to be at an increased risk of IHD but the excess risk is so small that it has little clinical relevance.

  • 2.
    Emilsson, Louise
    et al.
    Primary Care Res Unit Vårdcentralen Värmlands Nysäter, Värmland County, Karlstad, Sweden; Inst Hlth & Soc, Dept Hlth Management & Hlth Econ, Univ Oslo, Oslo, Norway.
    Lebwohl, Benjamin
    Dept Med, Celiac Dis Ctr, Columbia Univ Coll Phys & Surg, New York NY, USA; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Sundstrom, Johan
    Uppsala Clin Res Ctr, Dept Med Sci, Uppsala Univ, Uppsala, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Örebro University Hospital, Örebro, Sweden.
    Cardiovascular disease in patients with coeliac disease: A systematic review and meta-analysis2015In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 47, no 10, p. 847-852Article in journal (Refereed)
    Abstract [en]

    Background: Coeliac disease has been associated with an increased risk of cardiovascular disease in some studies, whereas other studies have shown no association. We performed a systematic review and meta-analysis of cardiovascular disease in celiac disease. Methods: Pubmed, Cinahl, EMBASE and Medline via Ovid were searched for relevant articles published until January 5, 2015. English-language articles on studies with more than 20 patients were included, and were quality rated using the GRADE risk of bias tool. We used random-effects models and assessed heterogeneity using the I-2 statistic. Results: Ten studies were relevant, reporting the risk of myocardial infarction, cardiovascular death and stroke in 33,128/32,903/32,466 coeliac disease patients respectively. Only one study examined celiac disease and a composite measure of cardiovascular disease and this study found a hazard ratio of 1.10 (95% CI 1.03-1.28). In a meta-analysis, we observed an increased risk of stroke (OR 1.11; 95% CI 1.02-1.20). The risks of myocardial infarction (OR 1.12; 95% CI 0.83-1.40) and cardiovascular death (OR 1.12; 95% CI 0.96-1.29) were similar but were estimated with less certainty. Heterogeneity was low for all outcomes except for myocardial infarction where it was moderate. Conclusion: Coeliac disease was associated with a modestly increased risk of cardiovascular disease, but the evidence base is limited.

  • 3.
    Emilsson, Louise
    et al.
    Vardctr Varmlands Nysater, Primary Care Res Unit, S-66195 Varmlands Nysater, Varmland County, Sweden.;Univ Oslo, Inst Hlth & Soc, Dept Hlth Management & Hlth Econ, N-0316 Oslo, Norway..
    Sultan, Alyshah Abdul
    Univ Nottingham, City Hosp, Div Epidemiol & Publ Hlth, Clinical Sci Bldg,Hucknall Rd, Nottingham NG5 1PB, England.;Nottingham Univ Hosp NHS Trust, Biomed Res Unit, Nottingham Digest Dis Ctr, Natl Inst Hlth Res, Nottingham, England.;Univ Nottingham, Nottingham NG7 2RD, England..
    Ludvigsson, Jonas F.
    Örebro University Hospital. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.; Dept Pediat.
    No increased mortality in 109,000 first-degree relatives of celiac individuals2016In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 48, no 4, p. 376-380Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have shown an excess mortality in individuals with celiac disease (CD). However, it is unknown if also first-degree relatives (FDRs) to celiac patients are at increased risk of death. Aim: We aimed to assess mortality in FDRs to celiac patients. Methods: Individuals with CD were identified through biopsy reports (equal to Marsh grade III). Each celiac individual was matched on sex, age, county and calendar year with up to five control individuals. Through Swedish healthcare registries we identified all FDRs (father, mother, sibling, offspring) of CD individuals and controls. Through Cox regression we calculated hazard ratios (HRs) for mortality (all-cause death, circulatory, cancer and other). Results: We identified 109,309 FDRs of celiac individuals and 549,098 FDRs of controls. Overall mortality was increased in FDRs to celiac individuals (HR = 1.02, 95%CI = 1.00-1.04, p = 0.03). This corresponded to an excess risk of 5.9 deaths per 100,000 person-years of follow-up. When limiting follow-up to time since celiac diagnosis in the index individual, we found no increased risk of death (HR = 1.01; 95%CI = 0.98-1.03). Conclusion: FDRs to individuals with CD are at increased risk of death. This excess risk is however minimal and unlikely to be of any clinical importance to the individual. (C) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  • 4.
    Emilsson, Louise
    et al.
    Primary Care Res Unit Vårdctr Värmlands Nysäter, Värmland County, Karlstad, Sweden; Inst Hlth & Soc, Dept Hlth Management & Hlth Econ, Univ Oslo, Oslo, Norway.
    Wijmenga, Cisca
    Dept Genet, Univ Med Ctr Groningen, Univ Groningen, Groningen, Netherlands.
    Murray, Joseph A.
    Dept Internal Med, Div Gastroenterol & Hepatol, Mayo Clin, Rochester MN, USA.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Örebro University Hospital, Örebro, Sweden.
    Autoimmune Disease in First-Degree Relatives and Spouses of Individuals With Celiac Disease2015In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 13, no 7, p. 1271-1277.e2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: First-degree relatives of individuals with celiac disease are at increased risk for this disorder, but little is known about their risk for other autoimmune diseases. We assessed the risk of nonceliac autoimmune disease in first-degree relatives and spouses of people with celiac disease. METHODS: We identified individuals with celiac disease by searching computerized duodenal and jejunal biopsies, collected from 1969 through 2008, at 28 pathology departments in Sweden. Celiac disease was identified based on biopsy reports of villous atrophy (equal to Marsh grade 3; n = 29,096). Individuals with celiac disease were matched with up to 5 controls (people without celiac disease) for sex, age, county, and calendar year (total, 144,522 controls). Through Swedish health care registries, we identified all first-degree relatives (fathers, mothers, siblings, and offspring) and spouses of individuals with celiac disease (n = 84,648) and controls (n = 430,942). We used Cox regression analysis to calculate hazard ratios (HRs) for nonceliac autoimmune disease (Crohn's disease, type 1 diabetes mellitus, hypothyroidism, hyperthyroidism, psoriasis, rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, or ulcerative colitis) in these groups. RESULTS: During the follow-up period (median, 10.8 y), 3333 of the first-degree relatives of patients with celiac disease (3.9%) and 12,860 relatives of controls (3.0%) had an autoimmune disease other than celiac disease. First-degree relatives of people with celiac disease were at increased risk of nonceliac autoimmune disease, compared with controls (HR, 1.28; 95% confidence interval, 1.23-1.33), as were spouses (HR, 1.20; 95% confidence interval, 1.06-1.35). Risk estimates for nonceliac autoimmune disease did not differ between first-degree relatives and spouses of individuals with celiac disease (interaction test: P =.11). HRs for nonceliac autoimmune disease were highest in the first 2 years of follow-up evaluation. CONCLUSIONS: First-degree relatives and spouses of individuals with celiac disease are at increased risk of nonceliac autoimmune disease. In addition to genetic factors, environmental factors and ascertainment bias might contribute to the increased risk of autoimmunity in first-degree relatives of individuals with celiac disease.

  • 5.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; Department of Paediatrics, Örebro University Hospital, Örebro; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
    Jarrick, Simon
    Örebro University, School of Medical Sciences. Department of Paediatrics.
    Murray, Joseph A.
    Department of Immunology, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN, USA.
    Emilsson, Louise
    Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA; Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden.
    Celiac Disease and Risk of Henoch-Schonlein Purpura Population-based Cohort Study2018In: Journal of Clinical Gastroenterology, ISSN 0192-0790, E-ISSN 1539-2031, Vol. 52, no 2, p. 141-145Article in journal (Refereed)
    Abstract [en]

    Background and Aims: A recent study found a 10-fold increased risk of celiac disease (CD) in individuals with Henoch-Schonlein purpura (HSP), but the confidence interval (CI) was wide.

    Methods: The retrospective cohort study of all patients with CD in Sweden, diagnosed through small intestinal biopsy from 1969 to 2008 (n = 29,077). Each individual with CD was matched to up to 5 controls (n = 144,433). Data on study participants were linked to diagnostic codes for HSP in the National Patient Registry. Through Cox regression we estimated hazard ratios for CD and later HSP. Through logistic regression we calculated odds ratios for HSP preceding CD.

    Results: During follow-up 19 individuals with CD and 99 controls developed HSP. This corresponded to a hazard ratio of 0.96 (95% CI, 0.59-1.56). Looking backward, we found no increased risk of earlier HSP in patients with CD (odds ratio = 1.02; 95% CI, 0.601.72).

    Conclusions: In this study of more than 29,000 patients with CD, we found no increased risk of HSP before or after CD.

1 - 5 of 5
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