People with Celiac disease may have twice the risk of coronary artery disease.

Celiac disease has already been linked to arrhythmias, or irregular heartbeats, and possible heart failure. Now, a new study has found that people with celiac disease have almost a two-fold increased risk of coronary artery disease (CAD), compared to the general population. The study also suggests a slightly higher risk for stroke among people with celiac compared to their peers.

According to the Celiac Disease Foundation (CDF), celiac disease is estimated to affect 1 in 100 people worldwide. 2.5 million Americans remain undiagnosed and are at risk for long-term health complications, according to CDF.

The study, which was recently presented at the American College of Cardiology’s 63rd annual scientific session, contributes to efforts to understand how inflammation and autoimmune processes might affect the development of heart vessel disease.

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Celiac disease is a chronic inflammatory condition of the digestive system that can damage the small intestine. It can eventually interfere with the absorption of key nutrients in the body. People with celiac disease are unable to tolerate gluten, a protein found in wheat, rye, oats, and barley, which is believed to trigger an immune and inflammatory response in the gut.

Celiac disease is hereditary, meaning that it runs in families. People with a first-degree relative who has celiac disease (a parent, child, or sibling) have a 1 in 10 risk of developing the condition.

Experts believe that up to 80 percent of people with celiac disease are underdiagnosed or misdiagnosed, with conditions such as lactose intolerance and irritable bowel syndrome. Previous research has shown that celiac disease has been on the rise and is four times more common now than it was 50 years ago.

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Dr. R.D. Gajulapalli, a clinical associate at the Cleveland Clinic and co-investigator of the study, said in a press statement, “People with celiac disease have some persistent low-grade inflammation in the gut that can spill immune mediators into the bloodstream, which can then accelerate the process of atherosclerosis and, in turn, coronary artery disease.”

Gajulapalli went on to say that the study findings reinforce the idea that chronic inflammation, from an infection or a disease, can have an adverse effect on the stiffness of the arteries and on heart health in general.

Researchers looked at the electronic health records of patients aged 18 and older from 13 participating health care systems in the U.S. between January 1999 and September 2013. Among almost 22.4 million patients, 24,530 had been diagnosed with celiac disease. Patients without celiac disease served as controls. There was no difference in smoking status or diabetes rates between the two groups. Patients with celiac disease were slightly more likely to have high cholesterol, but less likely to have high blood pressure.

Risk factors for coronary artery disease, which include sex, race, diabetes, high cholesterol, high blood pressure, and smoking were checked between patients with celiac disease and controls to make sure they were comparable.

Researchers found a significantly higher rate of CAD among patients with celiac disease compared to the control population (9.5 percent vs. 5.6 percent).

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This study highlights a specific patient population who might be at higher risk for CAD, even in the absence of traditional risk factors, Gajulapalli said. The researchers were surprised by the strength of the association, especially in younger people, and he urged patients and doctors to be aware of this link.

Gajulapalli said that more studies are needed to determine whether patients with celiac disease will need more intense risk factor modification, as is the case for diabetic patients who have CAD. He advised people with celiac disease and other inflammatory diseases to maintain a healthy lifestyle and be mindful of traditional cardiovascular risk factors, including diabetes, high blood pressure, and high cholesterol.

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