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loaf of bread with a 'gluten free' label

A study led by researchers at Oxford Population Health has highlighted that there is an urgent need for more research to help us understand why people with coeliac disease may have an increased risk of developing cardiovascular disease.

Around 1% of the UK population has coeliac disease, an autoimmune condition caused by an exaggerated reaction to gluten, a dietary protein found in wheat, barley, and rye. The condition is more common in women and is typically diagnosed in childhood and adolescence, or between the ages of 40 and 60.

The published evidence on whether or not coeliac disease is associated with an increased risk of developing cardiovascular disease varies. The researchers found that previous studies tended not to consider how traditional cardiovascular risk factors, such as high blood pressure or increased levels of LDL (or ‘bad’) cholesterol, might impact a person with coeliac disease’s chances of developing cardiovascular disease.

To investigate whether or not traditional cardiovascular risk factors contribute to the link between coeliac disease and an increased risk of developing cardiovascular disease, the researchers analysed data from half a million UK Biobank participants aged between 40 and 69 at the time the data were collected.

Of the 469,095 participants, 2,083 had coeliac disease but no evidence of cardiovascular disease when the initial data were collected. The cardiovascular health of these participants was monitored, using linked hospital records and death certificates, for an average of just over 12 years. Participants with coeliac disease were more likely to be women (56%) and of white ethnicity (95%), when compared to participants who didn’t have the condition.

Key findings:

  • During the 12 year monitoring period, 40,687 diagnoses of cardiovascular disease were recorded among all the surviving UK Biobank participants;
  • 218 of these diagnoses were in people with coeliac disease, equivalent to a rate of 9 in every 1,000 people. In those without coeliac disease, there were 7.4 diagnoses of cardiovascular disease per 1,000 people;
  • Coeliac disease was associated with a 44% higher risk of cardiovascular disease after accounting for a wide range of potentially influential lifestyle, medical and cardiovascular disease factors;
  • The risk of developing cardiovascular disease appeared to increase with the length of time that a person had been living with coeliac disease. The results showed a 30% higher risk among those who had had coeliac disease for less than 10 years, rising to 34% among those who had had it for 10 years or more;
  • Participants with coeliac disease had fewer known risk factors for cardiovascular disease, including obesity, high blood pressure, a history of smoking, and high cholesterol, and were more likely to have ‘ideal’ cardiovascular health (also described as ‘low’ risk) despite the incidence of cardiovascular of disease in this population.

Megan Conroy, lead author of the study and an epidemiologist at Oxford Population Health, said ‘This study highlights the importance of cardiovascular disease as a potential complication of coeliac disease. Given the lower occurrences of known risk factors in participants with coeliac disease who then developed cardiovascular disease, further research is needed to identify the cause of the increased risk affecting this population. Our research indicates that clinicians should make patients with coeliac disease aware of the elevated risk, and work with them to optimise their cardiovascular health.’                                                                                                                                                                                                                                         

The researchers note that this is an observational study and cannot establish cause and effect. The researchers also acknowledge various limitations to their findings, including that cardiovascular risk scores were only measured once.