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Celiac.com 11/14/2022 - Some studies have linked coronary artery disease with celiac disease, but hard evidence is scant. To date, there has been no solid medical literature on common risk factors linking celiac disease and coronary artery disease. Risk factors for coronary artery disease include hypertension, hyperlipidemia, type 2 diabetes, obesity, and tobacco use. However, common risk factors connecting celiac disease and coronary artery disease are poorly documented. A team of researchers recently set out with three goals. First, to assess potential demographic differences between celiac patients with coronary artery disease and without coronary artery disease. Secondly, to examine the risk factors of coronary artery disease in celiac patients. Lastly, to compare celiac-coronary artery disease patients and matched non-celiac coronary artery disease to see if there are more coronary artery disease risks for people with celiac disease. The research team included Maryam B. Haider, Paul Naylor, Avijit Das, Syed M. Haider, and Murray N. Ehrinpreis. They are variously affiliated with the Department of Gastroenterology Gastroenterology at Wayne State University in Detroit, MI; the DMC/Wayne State University - Sinai Grace Hospital in Detroit, MI; the Wayne State University School of Medicine in Detroit, MI; and Binghamton University in Binghamton, NY. For their nationwide retrospective case-control study, the team used the National Inpatient Sample (NIS) database to identify patients admitted between 2016 and 2018 with a principal or secondary diagnosis of celiac disease. They then assessed sociodemographic and clinical risk factors for coronary artery disease in celiacs, and compared the celiac-coronary artery disease patients with the matched non-celiac coronary artery disease group. Of nearly 24,000 hospitalizations with celiac disease from 2016 to 2018, nearly 20%, were found to have coronary artery disease. Established coronary artery disease risk factors for celiac patients included hypertension, hyperlipidemia, type 2 diabetes, and a family history of coronary artery disease. Interestingly, tobacco use is not a coronary artery disease risk factor in celiac patients. Odds of coronary artery disease were 55% less likely for female celiac patients, compared to male patients. The odds of coronary artery disease were 20% greater in patients with essential hypertension, double in patients with type 2 diabetes, and five times higher in celiac patients with hyperlipidemia. Patients with coronary artery disease had higher rates of iron deficiency anemia, which were nearly 10% for celiac-coronary artery disease patients, compared with just under 8.3% for non-coronary artery disease celiac patients, and just over 7.3% for people with non-celiac coronary artery disease. The team's findings confirm that, as with non-celiac individuals, males and individuals of Caucasian race with celiac disease face a higher risk of coronary artery disease. They also confirmed that celiac-coronary artery disease patients have a higher rates of hyperlipidemia than non-celiac coronary artery disease patients, while celiacs with type 1 diabetes have an early diagnosis of coronary artery disease, compared to celiacs with type 2 diabetes. Lastly, they found that iron deficiency anemia is an important risk factor for coronary artery disease in those with celiac disease. Teasing out the common links and risk factors for celiac disease and coronary artery disease is important work, and this study helps to advance that cause. Clearly further, and larger, study will be helpful in our ongoing journey to understand the puzzle that makes up the links celiac, coronary artery disease, and other diseases. Read more in Cureus 14(6): e26151
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Celiac Disease and Heart Disease: One Chain, Many Links
Brian Dean, R.D., MS posted an article in Summer 2011 Issue
Celiac.com 12/07/2018 - What do hypertension, obesity, smoking and celiac disease have in common? They’re all important risk factors for coronary heart disease (CHD), a disease that kills more than a half a million people annually in the U.S. alone.(1) Based on emerging research, celiac disease may be a major contributor to heart disease in the Western world –making celiac disease an even greater public health threat than is currently understood. CHD and Celiac Disease: A Brief History The connection between CHD and celiac disease has a 35-year history. It began with a 1976 study conducted by Southampton University Hospital researchers, who found that there was an “… apparent protective effect of coeliac disease on CHD risk which “…might result from malabsorption of dietary lipids.”(2) However, this study had a number of significant flaws including a small sample size of only seventy seven. The most significant confounder in this study was the mortality rate of young subjects, which precluded them from the privilege of living long enough to develop CHD. Additionally, our understanding of CHD has undergone a paradigm shift since the low-fat 1970’s. CHD is not the result of excess dietary fat consumption, but instead is a manifestation of prolonged inflammation.(3) Based on this study and two others published around the same time period which found no link between CHD and celiac disease, researchers largely stopped investigating the heart health of people with celiac disease. The assumption was that celiac disease provided protection or, at the very least, was benign in terms of CHD risk. Then came a paper published in the July 2003 Archives of Internal Medicine which reported that celiac disease patients had a sixty percent increased risk of CHD death.(4) More recently, in a January 2011 Circulation paper, Swedish researchers published eye-catching results from an investigation of more than 15,000 individuals with celiac disease.(5) The key finding from this research was an approximately twenty percent increased risk of CHD death in people with celiac disease. While this research remains in its infancy, the biological connections between celiac disease and CHD are crystal clear, bolstering the epidemiological findings that people with celiac disease are at heightened CHD risk. CHD Today Before delving into the physiological link between CHD and celiac disease, it’s crucial to understand the pathogenesis of atherosclerosis, or narrowing of the heart’s arteries. Atherosclerosis begins with an injury to the endothelial lining of the coronary artery. A hyperactive response by immune cells, particularly macrophages and inflammatory cytokines, causes macrophage cells to become lodged inside the injured endothelium. Through a complex cascade of cell signaling, “trapped” macrophages transform into what are known as foam cells. These foam cells take in circulating blood lipids, especially low density lipoproteins (LDL). Over time this LDL/foam cell mishmash transforms into the arterial plaque most people are familiar with.(6) Inflammation fuels atherosclerosis from start to finish –from the initial injury to the development and accumulation of plaque. The Inflammation Connection Unfortunately, inflammation is something that people with celiac disease have more than enough of. Serum C-reactive protein (CRP) is a commonly used parameter for celiac disease diagnoses –suggesting that nearly all uncontrolled celiac disease patients have elevated inflammation levels.(7) CRP also happens to be a more sensitive indicator of impending heart disease risk than serum cholesterol. Cleveland Clinic cardiologist Eric Topol claims that “…in the past, people talked about their cholesterol levels. In the next decade everyone will need to know their C-reactive protein level (a marker of inflammation).”(8) Other inflammatory mediators –such as IL-6 and TNF-a—are also present in greater amounts in celiac disease patients compared to the general population. In addition to the inflammatory response to ingested gluten, a March 2009 genetic analysis found that individuals with celiac disease were more likely to have polymorphisms that promote inflammatory cytokine production. (9) Other Links in the Chain And, there’s more to this celiac disease/CHD story than inflammation. People with celiac disease tend to have comorbidities that compound celiac disease’s damage to the cardiovascular system. Fat Malabsorption Dietary fats are a heart-health double edged sword. Excessive intake of trans fats are strongly linked to dyslipidemia and heart disease. However, a recent American Journal of Clinical Nutrition meta-analysis which included over 340,000 research subjects in its analysis found no connection between saturated fat and heart disease. (10) Monounsaturated and polyunsaturated fats are protective against atherosclerosis. Omega-3 fats appear to confer a particularly strong cardiovascular disease prevention benefit.(11) Adequate intake and absorption of fats is crucial for CHD prevention. Indeed, a low-fat dietary pattern was shown to increase heart disease risk in a large-scale randomized control trial involving more than 48,000 subjects.(12) Absorption of dietary fats is severely impacted by celiac disease due to villous atrophy, pancreatic insufficiency and dysbiosis. Lewis et al found that untreated celiac disease patients had approximately twenty one percent lower serum cholesterol levels compared to the general population, suggesting severe fat malabsorption.(13) Based on this research and others it’s conceivable that many celiac disease patients don’t absorb the dietary fats required to combat heart disease. Vitamin Malabsorption Suboptimal nutrient absorption is a near-universal issue in celiac disease patients – even for individuals consuming a gluten free diet. Fat soluble vitamin absorption is particularly affected by celiac disease.(14) Poor absorption of fat soluble vitamins E and D has been tied to increased heart disease risk in several studies. (15) Homocysteine Homocysteine is an amino acid that becomes elevated in cases of vitamin B6, folic acid or vitamin B12 deficiency. Poor B-complex vitamin absorption is common in both newly diagnosed celiac disease and in celiac disease patients following a gluten free diet.(16) An October 2002 Meta-analysis found that homocysteine levels twenty five percent above normal levels boosted heart attack risk by eleven percent.(17) Due to its strong correlation with heart disease, the American Heart Association suggests that individuals with malabsorption symptoms, including celiac disease, should be screened for homocysteine.(17) Simone Saibeni, MD and her University of Milan colleagues justified this recommendation by finding that celiac disease patients were 3.5 times more likely to have elevated hyperhomocysteinemia than the general population.(16) Type 1 Diabetes (DM1) Approximately five percent of people with celiac disease also suffer from DM1.(18) Hyperglycemia promotes inflammation, endothelium stiffness and arterial plaque formation. Rheumatism Symptoms of rheumatism, especially Sjogrens syndrome and unexplained joint pain, are common symptoms of undiagnosed celiac disease. Lubrano et al found that twenty five percent of individuals with celiac disease also have arthritis.(19) A 2008 population study discovered that people with rheumatoid arthritis have double the heart attack and stroke risk of the general population.(20) Whole Grain Intake Whole grain intake is strongly associated with a decreased risk of CHD.(21). Avoidance of fortified whole grains by people with celiac disease may impact dietary intake of B-vitamins, dietary fiber and antioxidants. How People With Celiac Disease Can Fight CHD Preventing CHD in the celiac disease population isn’t dramatically different from what’s typically recommended to the general population. Maintaining a healthy body weight, eating adequate amounts of dietary fiber, staying physically active, avoiding trans fats and consuming monounsaturated fats regularly are the keys to cardiovascular health whether or not one has been diagnosed with celiac disease. However, there are a few important heart health caveats that those with celiac disease should keep in mind. Gluten-Free Diet The importance of a 100 percent gluten free diet for CHD risk reduction and overall health cannot be emphasized enough. Not only is it the most effective treatment for celiac disease, but it is also critical for limiting the inflammatory response that promotes atherosclerosis.(22,23) Additionally, a strict gluten free diet allows the intestine to heal and recover, boosting absorption of nutrients necessary for cardiovascular health. Multivitamin Supplementation Multivitamin/Multimineral supplementation is standard treatment for celiac disease today.(24) Supplementation helps partly compensate for malabsorption and suboptimal intake of vitamins and minerals. A multivitamin supplement for CHD prevention should include at least 100 percent of the RDA for folic acid, vitamin B12, vitamin B6, and fat-soluble vitamins D and E. Dietary Fats “Fat is the most commonly and severely affected nutrient in celiac disease,” reports Jay W. Marks, M.D., of Baylor University College of Medicine.(25) Individuals with celiac should aim to consume at least twenty five percent of their calories in the form of dietary fat. Healthy monounsatured and polyunsatured fat sources such as extra virgin olive oil, nuts, legumes, fatty fish, and seeds should form the foundation of a heart healthy celiac disease diet. Pancreatic enzymes may be used to aid lipid absorption and reduce gastrointestinal symptoms like diarrhea and bloating. Omega-3 Fats Omega-3 fats reduce inflammation, increase HDL cholesterol and make cardiovascular arteries resistant to injury. Zhang et al discovered that habitual fish consumption was associated with a forty percent reduction in CHD mortality in healthy populations.(26) Omega-3 fatty acids may have additional benefits for celiac disease patients, especially acceleration of intestinal healing. Celiac disease patients should consume fatty fish like mackerel and salmon at least twice weekly. Conclusion Celiac disease needn’t be an automatic CHD death sentence. Although the connection between heart disease and celiac disease is very real, lifestyle changes can dramatically reduce the chances that someone with celiac disease will develop CHD. Simply eating a gluten-free diet, supplementing with vitamins, minerals and pancreatic enzymes and consuming omega-3 fats –four measures that those with celiac disease should be doing anyway – will shield the cardiovascular system from much of the celiac disease-derived damage that can lead to CHD. In fact, this new link can ultimately become a net positive for many celiac disease patients as it can motivate them to become more proactive and aggressive in their self-care. References: 1. Centers for Disease Control and Prevention; Heart Disease Facts. Accessed April 18th 2011. 2. Whorwell PJ, Foster KJ, Alderson MR, Wright R. Death From Ischaemic Heart-Disease and Malignancy in Adult Patients With Celiac Disease. Lancet 1976;113-114. 3. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease, application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation [serial online].2003;107:499-511 4. Peters U, Askling J, Gridley G, et al. Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med. 2003;163:1566–1572. 5. Ludvigsson JF, James S, Askling J, Stenestrand U, Ingelsson E. Nationwide cohort study of risk of ischemic heart disease in patients with celiac disease. Circulation. 2011 Feb 8;123(5):483-90 6. Gotta A, Farmer F. Atherosclerosis: Pathogenesis, Morphology, and Risk Factors. Cardiovascular Medicine. 3rd Edition, Springer, London, pp. 1593-1613. 7. Lahat N, Shapiro S, Karban A, et al. Cytokine profile in coeliac disease. Scand J Immunol 1999;49:441–446 8. Role of inflammation-Growing proof inflammation is a major risk factor for heart disease. Available at: Updated 8/02. Accessed April 18th 2011. 9. Dema B, Martínez A, Fernández-Arquero M, The IL6-174G/C polymorphism is associated with celiac disease susceptibility in girls. Hum Immunol 2009;70:191-4 10. Siri-Tarino SW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr [serial online]. 2010;91:535-546. 11. Perez-Jimenez F, Lopez-Miranda J, Mata P. Protective effect of dietary monounsaturated fat on arteriosclerosis: beyond cholesterol. Atherosclerosis 2002;163:385–98 12. Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006; 295:655-66 13. Lewis NR, Sanders DS, Logan RF, Fleming KM, Hubbard RB, West J. Cholesterol profile in people with newly diagnosed coeliac disease: a comparison with the general population and changes following treatment. Br J Nutr. 2009 Aug;102(4):509-13 14. Hallert C, Grant C, Grehn S, Granno C, Hulten S, Midhagen G, Strom M, Svensson H, Valdimarsson T. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther. 2002;16:1333–1339 15. Sesso HD et al.Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA. 2008 Nov 12;300(18):2123-33 16. Saibeni S, Lecchi A, Meucci G, et al. Prevalence of hyperhomocysteinemia in adult gluten-sensitive enteropathy at diagnosis: role of B12, folate, and genetics. Clin Gastroenterol Hepatol 2005;3:574e80 17. Malinow MR, Bostom AG, Krauss RM. Homocyst(e)ine, diet, and cardiovascular diseases: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation. 1999;99:178–182 18. Ludvigsson JF, Olsson T, Ekbom A, Montgomery SM. A population-based study of coeliac disease, neurodegenerative and neuroinflammatory diseases. Aliment Pharmacol Ther 2007; 25:1317 19. Lubrano E, Ciacci C, Ames PR, et al. The arthritis of celiac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996;35:1314-8 20. Dhawan SS, Quyyumi AA. Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep. 2008;10:128-133 21. Jensen MK, Koh-Banerjee P, Hu FB, et al. Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. Am J Clin Nutr. 2004;80(6):1492-1499 22. Meresse B, Cerf-Bensussan N. Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis. Mucosal Immunol. 2009;2:8e23 23. Popa C, Netea MG, van Riel PL, van der Meer JW, Stalenhoef AF. The role of TNF-a in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk. J Lipid Res. 2007;48:751–62 24. See J, Murray JA. Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin Pract. 2006;21(1):1-15. 25. Marks, J. “Celiac Disease (Gluten Enteropathy)”Available at: https://www.medicinenet.com/celiac_disease_gluten_enteropathy/article.htm. Accessed April 29th 2011. 26. Zhang J, Sasaki S, Amano K, et al. Fish consumption and mortality from all causes, ischemic heart disease, and stroke: an ecological study. Prev Med. 1999; 28: 520–529.-
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Celiac.com 04/20/2020 - From 2005 to 2014, hospitals recorded a sharp rise in the numbers of celiac disease patients admitted for acute myocardial infarction (AMI), according to researcher presenting at the ACC.20 World Congress of Cardiology. A team of researchers recently set out to review the Nationwide Inpatient Sample for adults with AMI as a primary diagnosis, and celiac disease as a secondary diagnosis, between 2005-2014. The research team included Manish Gupta, Muhammad Umair Bakhsh and Kamesh Gupta. They are variously affiliated with the Danbury Hospital, Danbury, CT, USA, and the Baystate Medical Center in Springfield, MA, USA. The team identified nearly 6.2 million AMI hospitalizations, of which 3,169 also had a diagnosis for celiac disease. Using survey regression, the researchers figured adjusted odds ratios (aOR) for hospital mortality, and other outcomes. The data showed that the rate of AMI-related hospitalization of celiac patients rose from 0.015% in 2005 to 0.076% in 2014. The results showed that celiac+AMI patients tended to be a few years older, on average, and substantially more likely to be female. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, the researchers observed that celiac+AMI hospitalizations had a lower odds-ratio for hospital mortality. Also, the results showed a slightly shorter length of stay for celiac+AMI patients, but much higher average hospitalization charges of just over $64,058 for celiacs, compared just over $60,000 for non-celiac AMI patients. The data show that the number of celiac disease patients admitted for acute myocardial infarction (AMI) rose five times from 2005 to 2014, yet, for unknown reasons, the rates of in-hospital mortality is lower for these patients than in patients without celiac disease. The study shows that even though inflammation seems to be causing more AMI hospitalizations in people with celiac disease, celiac patients seem to fare better than non-celiacs. This study illustrates very clearly some of the higher costs, both physically and monetarily, of having celiac disease. Celiacs see more hospital admissions for AMI-related issues, and it costs them more money, even though their stay is usually a bit shorter. The fact that their odds of dying as a result are lower is just one small consolation. Have you or a loved one been treated for an AMI-related heart condition? Do you have celiac disease? Share your thoughts below. Read more in the Journal of the American College of Cardiology. Volume 75, Issue 11 Supplement 2, March 2020 Read more at Openwirenews.com
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Celiac.com 12/12/2017 - Does a gluten-free diet have any effect on cardiovascular risk in people with celiac disease? Does it effect people without celiac disease? So far, both questions have remained unanswered. Recently, a team of researchers set out to conduct a systematic review to shed some light on the matter. The team was led by Michael D.E. Potter, MBBS (Hons), from the University of New Castle, Australia. The team focused their review on the "potential of the gluten-free diet to affect modifiable cardiovascular risk factors including weight, blood pressure, cholesterol and blood sugars," and to do this they searched for "studies which measured these risk factors in individuals before and after the institution of a gluten-free diet." In all, Potter and colleagues reviewed 27 studies that evaluated the effect of a gluten-free diet, as followed for a minimum of 6 months, on cardiovascular risk factors such as BMI, waist circumference, blood pressure, fasting glycemia, hemoglobin A1c and serum lipids. Despite their efforts, they found no clear evidence that a gluten-free diet increases cardiovascular risk in celiac patients. They found no evidence that it increases heart disease risk in people without celiac disease. They really found nothing much at all. While the results varied across studies, and researchers did see changes in some cardiovascular risk factors, they say the data do not support a gluten-free diet for cardiovascular health in individuals without celiac disease. True, perhaps. But it's also true that the data neither support nor condemn a gluten-free diet in people without celiac disease. Unless and until researchers get some solid data from large groups and can make accurate, informative comparisons between those groups, it seems foolish for them to advocate or discourage a gluten-free diet in people without celiac disease. Source: Healio.com
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