Some of the biggest risk factors for cardiovascular disease — including obesity, high blood pressure, and elevated cholesterol — are less common in people with celiac disease. But a new study suggests that people living with celiac disease are still more likely than other individuals to experience medical crises like heart attacks and strokes.
The new study, published January 30 in BMJ Medicine, examined data on nearly half a million adults in the ongoing UK Biobank project. This included 2,083 people who had celiac disease at the start of the study, and another 1,435 who developed this autoimmune condition during follow-up. None had a history of cardiovascular disease.
After a follow-up period of about 12.5 years, researchers identified more than 40,000 cardiovascular disease events like heart attacks, strokes, and a condition known as coronary artery disease, which involves damage or blockages in the heart’s major blood vessels. This total included 218 events among people with celiac disease.
Overall, people with celiac disease were 27 percent more likely to experience cardiovascular disease events than people without celiac disease, after accounting for a wide range of factors that might influence risk such as eating and exercise habits, preexisting medical conditions, and traditional risk factors like high blood pressure and obesity.
“People with celiac disease should be aware there may be an increased risk of cardiovascular disease and should discuss any concerns with their doctor,” says the lead study author, Megan Conroy, a public health researcher at the University of Oxford in England.
People With Celiac Disease Are More Likely to Have Few Traditional Risk Factors for Heart Disease
These conversations are especially important, because the study also found that people with celiac disease had a higher risk even when they didn't have traditional risk factors for cardiovascular disease.
The increased risk associated with celiac disease was even more pronounced among people who had few, if any, traditional risk factors for cardiovascular disease. Researchers looked specifically at the American Heart Association’s “Life’s Simple 7” traditional risk factors: smoking, an inactive lifestyle, an unhealthy diet, obesity, high blood pressure, elevated cholesterol, and high blood sugar.
Far more people with celiac disease had ideal cardiovascular risk scores according to these traditional risk factors than the participants without celiac disease — 23 percent versus 14 percent. Similarly, only 5 percent of people with celiac disease were high risk, compared with 9 percent of other people in the study.
Among all the low-risk people in the study, individuals with celiac disease were 64 percent more likely to experience events like heart attacks and strokes than individuals without the condition.
Several Autoimmune Conditions Are Associated With Increased Heart Disease Risk
The study wasn’t a controlled experiment designed to prove whether or how celiac disease might directly cause cardiovascular disease. Another limitation of the study is that researchers looked at cardiovascular risk factors only once, when people joined the study, and their risk might have subsequently changed. What’s more, researchers lacked data on whether the participants with celiac disease followed a gluten-free diet.
Even so, the study's findings support those of previous research suggesting that autoimmune diseases, including celiac disease, may increase the risk of heart attacks and strokes, says Nathalie Conrad, PhD, an autoimmune disease researcher at the Catholic University of Leuven in Belgium who wasn’t involved in the new study. For example, Dr. Conrad led a study published in the journal Lancet in August 2022 that found an association between autoimmune diseases and a 56 percent higher risk of cardiovascular disease events.
“The findings from this new study show that excess cardiovascular risk in celiac disease cannot solely be explained by conventional cardiovascular disease risk factors,” Conrad says.
What Should People With Celiac Disease Do in Light of These Findings?
Some doctors may treat traditional risk factors like high blood pressure more aggressively in people with celiac disease in order to minimize their cardiovascular disease risk, Conrad says. Medications that manage inflammation in people with autoimmune diseases may also protect the heart and blood vessels, but more research is still needed to examine this option, Conrad adds.
“There are no specific prevention measures for patients with autoimmune conditions or celiac disease,” Conrad says. “I am sure this will come. But for now, the best option would be for patients to follow the general screening and prevention measures for conventional cardiovascular disease risk factors.”