Cardiovascular Complications of Adult Celiac Disease: A 3-Year Experience at a Tertiary Care Center

Introduction: Celiac disease (CD) is an autoimmune disorder triggered by gluten exposure that harms the intestinal mucosa. Previous studies have shown there may be a connection between CD and an increased risk of developing coronary artery disease, which is caused by plaque accumulation in the arterial walls. Individuals with CD may also be more likely to develop hyperlipidemia and reduced ejection fraction. It is essential to closely monitor and manage cardiovascular risk factors in CD patients to prevent complications. Methods: A retrospective chart review of our institution’s electronic medical records was conducted from 2020-2022 to evaluate patients undergoing investigation for CD. Pathology was confirmed with duodenal biopsy. Subsequent analyses were performed to assess the relationship between CD status and various cardiovascular risk factors, including ASCVD score, ejection fraction based on an echocardiogram, and known history of coronary artery disease based on a positive stress test or angiogram. Results: A total of 312 patients (20% male) undergoing investigation for CD were identified. Thirty-seven patients (12%) were biopsy-positive. There was a statistically significant protective relationship between CD and ASCVD score with CD patients being 1.53 times more likely to have an ASCVD score < 5 [95% CI 1.29-3.95, P < 0.05] than non-CD patients. This relationship was independent when stratifying for age and BMI. There did not appear to be an association between CD and LVEF. However, when stratifying by BMI, CD patients with a BMI < 30 were 2.95 times more likely to have an LVEF < 55% [95% CI 2.18-10.64, P < 0.05]. When stratifying for age, this effect was particularly pronounced in CD patients between 70 and 79 years old who were 7 times more likely to have a LVEF < 55% [95% CI 8.82-20.6, P < 0.05] (Figure 1). Conclusion: CD may increase the risk of cardiovascular disease and subsequent complications. It highlights the need for careful cardiovascular risk management in people with CD, including interventions to lower gluten intake and enhance nutrient absorption. More research is required to understand the underlying mechanisms and extent of CD-induced cardiac pathology and to develop new preventive and therapeutic strategies to combat this.Figure 1.: A: Relationship Between ASCVD Score and Celiac Disease B: Relationship Between Left Ventricular Ejection Fraction (LVEF) and Celiac Disease Stratified by Body Mass Index (BMI).