The cardiovascular impacts of celiac disease: Research update

By Anastasia Climan, RDN, CD-N | Fact-checked by Barbara Bekiesz
Published February 22, 2024

Key Takeaways

  • Celiac disease may raise the risk of atherosclerosis, atrial fibrillation, ischemic heart disease, and myocarditis, but these risks may not be due to a patient’s lifestyle choices.

  • Patients with celiac may develop heart problems without the obvious predictive signs.

  • Gluten-free diets are necessary with celiac disease, but they often produce unfavorable metabolic effects.

There’s mixed research on whether celiac disease raises heart disease risk, with some studies demonstrating an obvious link. However, the connection between these inflammatory conditions does not appear to be a reflection of the lifestyle choices of those with celiac. In fact, studies show that many patients with celiac disease don’t display the telltale signs of trouble before a cardiac event strikes.

Here’s how clinicians can assess this subpopulation’s unique risk profile and protect vulnerable patients against this hidden threat.

Identifying predictors of heart disease

Authors of a literature review on the connection between celiac disease and cardiovascular disease cited various studies that identified heart disease risk factors in this population.[] 

Researchers in Sweden, for example, compared 1,075 patients with biopsy-confirmed celiac disease in a 1:5 ratio to the general population through a cross-sectional retrospective study.[]

Based on typical metrics for ischemic heart disease risk, this study indicated that people with celiac disease should theoretically experience lower rates of cardiovascular disease. 

In particular, the investigators found that the average BMI for those with celiac was 24.6 vs 26.1 in the comparison group. People with celiac were also less likely to actively smoke or have hypertension.

In addition, among patients hospitalized for myocardial infarction, those with celiac disease presented with a lower total cholesterol level than did those without.

A study in Britain utilizing a large dataset from the UK Biobank confirmed similar results.[][] The study additionally found that people with celiac disease tended to drink less alcohol. As for diabetes, the celiac group showed equal or lower rates of type 2 diabetes and a slightly higher incidence of type 1 diabetes.

The absence of smoking, high blood pressure, obesity, and high cholesterol levels can make it difficult to predict cardiovascular risk in patients with celiac disease.

Uncovering which specific heart conditions to look for can help inform better diagnostics.

Cardiovascular conditions associated with celiac

A key finding from the UK Biobank study showed that people with celiac disease had a 44% higher risk of cardiovascular disease overall. This risk increased proportionately over the years. Compared to newly diagnosed patients with celiac, the chances of developing heart disease increase the longer someone lives with celiac disease.

The authors of the literature review identified several studies that associated atrial fibrillation, ischemic heart disease, and myocardial infarction with celiac disease. 

Elevated systemic inflammation is believed to promote atherosclerosis and other cardiovascular diseases in those with celiac, as often seen with other autoimmune conditions. There are also some potential genetic links underlying both conditions.

Dietary impacts and other interventions

Gluten-free diets are the hallmark treatment for celiac disease, but it’s not clear whether the impact of this eating style has an overall positive or negative influence on heart disease risk. The literature review found a small study on celiac disease and comorbid autoimmune myocarditis that showed improvements in ventricular arrhythmia with a gluten-free diet. 

However, it’s possible that the replacement of high-fiber whole grains with high-sugar foods or processed gluten-free items may contribute to heart disease. In general, gluten-free diets are associated with unfavorable shifts in body composition. 

One study reported a significant uptick in metabolic syndrome within the first year of following a gluten-free diet (from 2% to 30%).[] Additionally, people with celiac disease on gluten-free diets had three times the rate of fatty liver disease than the general population did. While those with celiac must avoid gluten, they may need special counseling to ensure heart-healthy substitutions. 

Clinicians may mitigate some of these risks by encouraging adequate fiber intake through non-gluten sources, including vegetables and beans, and anti-inflammatory dietary choices favoring healthy fats. Promoting stress management and regular physical activity may also be especially relevant for this group. 

Finally, monitoring metabolic changes and providing support within the first year of going gluten-free can help patients establish lifelong strategies for living well.

What this means for you

Only further research can paint a clear picture of the cardiovascular impact of celiac disease. Currently, the need for targeted screening protocols remains. 

However, providers must be mindful of the potential for heightened risk, which will require time spent educating and empowering patients.

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