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Heart Failure, Cardiomyopathy and Celiac Disease By Laura Yick 02/26/2003 - The subject of cardiology-related symptoms of celiac disease and celiac disease-associated cardiological disease has not been reviewed. So, here I attempt to summarize readings of research papers and abstracts of research papers dealing with the topic. My interest in cardiac related issues in association with celiac disease is related to a familial history of hypertrophic cardiomyopathy which like celiac disease can be missed and some times before a person is found to have it he/she may experience an episode of sudden cardiac arrest, or syncope (fainting). End stage hypertrophic cardiomyopathy can look like dilated cardiomyopathy. Dilated cardiomyopathy has been associated with celiac disease.

Celiac disease and Cardiomyopathy and Heart Failure
A study of 642 patients who were candidates for heart transplant in Italy found that 1.9% had anti-endomysial antibodies (AEA) (compared to 0.35% of 720 healthy controls) and that 2.2% of 275 patients with dilated cardiomyopathy were AEA-positive (compared to 1.6% in the remaining transplant candidates) (Prati D, et al, 2002, Am J Gastroenterol 97:218; Prati D, et al, 2002, Dig Liver Dis 34:39). Although an association was found, there was no way to assess cause and effect. The AEA-positive patients and AEA-negative patients presented with similar cardiologic criteria and had similar 2-year post-transplant survival. Similar, but more limited findings were described in preliminary data (Curione M, et al, 1997, Lancet 354: 222). The authors suggest a study of whether a gluten-free diet improves cardiac function in such patients. A study in Italy found that 5% of 60 elderly (over 65 years) celiac disease patients died during the study due to heart failure (Gasbarrini G, et al, 2001, Gerontology 47:306). The authors determined that this was significantly higher than the non-celiac disease population, but dont give a non-celiac disease rate. Furthermore, 0.4% of 226 non-elderly adult celiac disease patients died with heart failure as the cause and this rate was not significantly higher than the comparable non-celiac disease population. Other cardiological symptoms and disorders were not assessed.

Common Causes?
In a case study, similar cellular changes were found in both the intestinal microvilli and the heart muscle of a patient who had both idiopathic congestive cardiomyopathy and celiac disease (Chuaqui B, et al, 1986, Pathol Res Pract 181:604). While this was a limited study and the molecular causes of each were not evaluated, it is an intriguing find. In another case study, a celiac disease patient also had recurrent hemoptysis and developed heart block (Mah MW, et al, 1989, Can J Cardiol 5:191). The authors hypothesize that there is a common cause of the symptoms above. The cause is undefined by the authors. Similarly, a patient who had chronic anemia, cardiomyopathy, and heart block but did not have digestive symptoms was found to have anti-gliadin antibodies (AGA), AEA, and anti-reticulin antibodies (ARA) as well as the typical celiac biopsy (Rubio JLC, et al, 1998, Am J Gastroenterol 93:1391). The authors found that after 1 year of gluten-free diet, blood tests and biopsy were normal and confirm celiac disease as a diagnosis; but they do not mention whether or not the cardiomyopathy and heart block resolved.

Celiac Disease and Autoimmune Myocarditis
In an Italian study, 187 patients, including 110 with heart failure and 77 with arrhythmias, diagnosed with myocarditis were tested for celiac disease (Frustaci A, et al, 2002, Circulation 105:2611). Thirteen patients had IgA tissue transglutaminase antibodies (tTGA); all had anemia. Nine of the thirteen were AEA-positive; these patients also had abnormal biopsies. Thus, 4.4% of myocarditis patients had celiac disease (they compare this to 0.6% in the non-myocarditis population; this was statistically significant. Eight of the nine myocarditis patients with celiac disease had HLA DQ2-DR3, the other patient had DQ2-DR5/DR7. Five of the nine myocarditis patients with celiac disease had heart failure and were treated with immunosuppression and gluten-free diet. The other four myocarditis patients with celiac disease had heart arrhythmias and were treated with gluten-free diet. All nine patients markedly improved in cardiologic features and were tTG- and AEA-negative post-treatment (8-12 months) .

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Other Cardiologic Diseases
Celiac Disease and Ischemic heart disease: In a report made in 1976, celiac disease was associated with a decrease in ischemic heart disease in 77 members of the Coeliac Society of England and Wales (Whorwell PJ, et al, 1976, Lancet 2:113). In another study with 653 celiac disease patients, the authors found no decrease in ischemic heart disease or stroke for celiac disease patients (Logan RF, et al, 1989, Gastroenterology 97:265). A recent study examined the risk factors for ischemic heart disease in dermatitis Herpetaformis patients (Lear JT, et al, 1997, J Royal Soc Med 90:247). The authors found that, compared to the normal population, dermatitis Herpetaformis patients had lower cholesterol, lower triglycerides, lower apolipoprotein B, lower fibrinogen, higher HDL2, smoked less, and were generally of higher social class.

Dermatitis herpetiformis has also been found to be associated with recurrent pericarditis (Afrasiabi R, et al, 1990, Chest 97:1006). The authors found IgG, IgA, and complement in the pericardium, thus demonstrating similarities with the skin deposition of IgA in dermatitis Herpetaformis lesions.

While there hasnt been a comprehensive review by a celiac disease researcher, the research papers summarized here point to a correlation of celiac disease with cardiomyopathy, heart arrhythmias, and heart failure. The authors of the articles summarized here often point to a probable association of autoimmune disease in both celiac disease and related heart diseases.

Glossary of terms:

  • Cardiomyopathy: aberrant heart muscle structure.
  • Congenital: non-inherited, usually referring to what is considered a "birth defect."
  • Heart block: blockage of the conduction of the heart electrical signaling system which regulates the heart beat.
  • Hemoptysis: spitting blood, usually due to lesions to the respiratory tract or voice box.
  • Idiopathic: often used to describe something whose origin is unknown.
  • Ischemic heart disease: heart damage due to insufficient blood flow to the heart (i.e., via the coronary arteries).
  • Myocarditis: inflammation of the heart muscle.
  • Pericarditis: inflammation of the pericardium, a sac which encloses the heart. welcomes your comments below (registration is NOT required).

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11 Responses:

G. LaValle
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said this on
08 Mar 2008 10:38:53 PM PST
I have celiac/dermatitis herpetaformis and presently referred to a cardiologist for possible pericarditis.

Mary-Frances Reavey
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said this on
06 May 2008 12:41:38 PM PST
First article I could find linking celiac with dilated cardiomyopathy. I have had heart problems for 10 years and was recently diagnosed with celiac disease and now all my 'heart numbers' are out of whack. My Cardiologist is on the ball and is doing further testing for cardiomyopathy as well as changing some of my meds . . he was also the doctor to first notice the anemia and started that ball rolling. . . hope to find more articles on this link.

Peter Robinson
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said this on
02 Nov 2008 4:59:31 AM PST
At 30 years old I self diagnosed celiac disease and went gluten free for about 10 years. At forty I resumed regular diet. I'm 57 and just had a heart attack (ischemic, right coronary artery. I had been on BP and chloresterol meds for 2 years, my total was 158 but HDL's only 26, to low. I suspect the same thing killed Dad.

Brian L. E.
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said this on
17 Feb 2010 7:58:26 AM PST
I am in the medical profession. I diagnosed myself with celiac disease after slowly eliminating parts of my diet. I am positive for allergy to gluten, including wheat, rye and oats. I developed heart block after a two mitral valve transplant. I had returned to school and decided to eat very excellent quality breads. Thereafter, I developed ischemia with heart block. I have a pacemaker now but was fine right after the mitral valve operation. My symptoms were near syncope just before bowel movement, relieved by bowel movement. I also developed swelling due to inflammation and also edema. I recently discovered the oat gluten residual affects, after I had eliminated all wheat gluten with great results. Now (in the last week, since eliminated the Quaker oats products), I do not have the near syncope symptoms. Thank you for a nice article, which I will give to my Doctor--I am a Veteran in the U.S., so I have great medical care.

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said this on
16 Oct 2010 7:39:51 PM PST
This is the first time I have ever heard anyone mention syncope before bowel movements. Doctors think I'm crazy and have no idea what I'm talking about. I have had many episodes of dropping blood pressure and near fainting before extreme episodes of diarrhea. I have always thought that I don't tolerate wheat but when I had blood tests they were negative. What causes the fainting? I have never heard of anyone else having that symptom.

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said this on
04 May 2011 9:42:33 AM PST
I have had the same thing for many years. I was diagnosed with IBS and told I would have to suffer. Fast forward about 10 years when my son was diagnosed with celiac disease. I decided to go gluten free to keep him safe in our home. All problems stopped! What I had experienced all those years was due to undiagnosed celiac disease.

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said this on
11 Apr 2010 1:47:32 PM PST
I recently self diagnosed myself with gluten intolerance or celiac. One of my symptoms has been heart palpitations and chest pain. I am an avid runner and have been my whole life, so the heart issues confused me. I had various other health issues that could not be diagnosed. One being severe muscle pains as well as the strange heart symptoms. I stopped eating gluten and this has all gone away. I've retested myself by reintroducing gluten. Muscle pain, palpations and heart pain come right back.

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said this on
31 Jan 2011 4:40:47 PM PST
My son and I are gluten-free, self-diagnosed Celiacs, though my blood tests do show a positive allergy to gluten. The results I've seen since we have been gluten-free are astounding.

My father died at age 50. He had numerous heart attacks prior to his death. Looking back, I wish I knew then what I know now. I wish he could have tried the gluten-free diet before I lost him.

I'm convinced the remaining of my family members are Celiac as well. I just wish I could convince them. My brother, at age 32, has already began following in my father's footsteps with heart attacks at an early age. He doesn't believe that he has any problem with gluten, but I honestly fear that I will lose him if I can't change his mind.

Glad that there are articles like this that I can share with him to try to get him to reconsider his diet.

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said this on
04 Apr 2011 7:40:59 AM PST
Very interesting. As I find more and more information, I am convinced that my father had celiac disease. He had classic symptoms like wasted buttocks and pot belly and flat feet. He was never diagnosed. My father had his first heart attack at age 63 and a fatal one at age 68. My paternal grandfather died at age 50 from a massive heart attack. My parents always wrote my grandfather's death off to his life style - cigarettes, alcohol and rich foods. Now, I'm thinking these heart attacks have to do with celiac disease.

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said this on
08 Dec 2011 7:52:18 PM PST
I am 29 years old and found out I am gluten intolerant 2 years ago through genetic testing from I had always had a bad stomach and odd ailments like heart palpitations, arthritis as a teenager, anxiety and panic attacks in my 20's I was diagnosed with "irritable bowel" over and over again and it wasn't until I went gluten free that all my ailments disappeared! No more 3X daily stomach aches, no passing out after eating a bowl of pasta and now my father keeps having heart episodes and Minor attacks! He has had 6 or 7 stents done in the past 3 years and the doctors are all baffled by it because his #'s are good! I'm trying to convince him to go gluten free, it's been a 2 year battle! He just had another stent today. I hope I can convince him before it's too late! I will be sending him this article!

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said this on
25 Jan 2013 9:10:35 AM PST

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Morning guys. So long story short. Lost 10 kg back late last year. Stress related I believe. ( I Understand this is a big factor with celiacs) Tested. Found anti bodies in my blood. Doctor states potential Celiacs. Have endoscopy. Doctor who takes procedure doubts I have it. ...

Getting a celiac disease diagnosis is shocking. Expect to go through all the stages of grief. Your best defense is to learn how to read labels, avoid cross contamination and consider eating as few processed foods for a few weeks. It may speed healing (wish someone would have advised me to do s...

That is very helpful. Thank you so much.

I would read it as ?high?. In any case, you were positive on the TTG and the DGP. You only need one positive. I had pretty severe intestinal damage and never even had a positive on the EMA or the TTG even when they were re-run several times during follow-up visits.

Thank you! That does help. I was just confused about the ?negative? under the EMA Titer when my level says ?1:40 high?. Any insight there? Just wondering if it?s further confirming or denying? I first thought confirming.