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Ischaemic heart disease in first-degree relatives to coeliac patients
Louise Emilsson1, Stefan James, Jonas F Ludvigsson
1Primary care research unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Medicine, Örebro University, Örebro, Sweden.
Insights
First-degree relatives of coeliac disease patients have a slightly increased risk of ischaemic heart disease. However, this small excess risk of heart disease has minimal clinical significance.
Area of Science:
- Gastroenterology
- Cardiology
- Genetics
Background:
- Coeliac disease (CD) is associated with an elevated risk of ischaemic heart disease (IHD).
- The genetic contribution to this increased IHD risk in CD patients is not fully understood.
Purpose of the Study:
- To investigate the risk of IHD in first-degree relatives and spouses of coeliac disease patients.
- To determine the potential genetic link between coeliac disease and excess IHD risk.
Main Methods:
- A cohort study using Swedish national registers (1969-2008).
- Coeliac disease patients (n=29,096) and matched controls were identified.
- First-degree relatives (n=87,622) and spouses (n=432,655) of patients and controls were analyzed for IHD incidence.
- Cox regression models were used to estimate hazard ratios (HR) adjusted for demographic factors.
Main Results:
- First-degree relatives of coeliac disease patients showed a statistically significant, albeit small, increased risk of IHD (HR=1.05; 95% CI=1.00-1.09).
- Spouses of coeliac disease patients did not exhibit an increased risk of IHD (HR=0.99; 95% CI=0.87-1.12).
- The excess IHD risk in affected relatives aged 40-59 years was 70 per 100,000 person-years.
Conclusions:
- First-degree relatives of individuals with coeliac disease appear to have a marginally elevated risk of developing IHD.
- The observed excess risk is minimal and likely lacks substantial clinical relevance for individual patient management.
Objective:
Coeliac disease (CD) has been linked to an increased risk of ischaemic heart disease (IHD). We examined the risk of IHD in first-degree relatives and spouses to coeliac patients to ascertain the genetic contribution to IHD excess risk.
Study Design And Setting:
Coeliac disease was defined as having a biopsy-verified villous atrophy (Marsh grade 3) in 1969-2008 (n = 29,096). Coeliac patients were matched to 144,522 controls. Through Swedish registers, we identified all first-degree relatives and spouses to coeliac patients and their controls, in total 87,622 unique coeliac relatives and 432,655 unique control relatives. Our main outcome measure was IHD defined according to relevant international classification of disease codes in the Swedish Inpatient Registry or in the Cause of Death Registry. Hazard ratios (HR) and confidence intervals (CI) were estimated through Cox regression adjusted for sex, age-group and calendar year at study entry of the relative.
Result:
During a median follow-up of 10·8 years, 2880 coeliac relatives and 13,817 control relatives experienced IHD. First-degree relatives of coeliac patients were at increased risk of IHD (HR = 1·05; 95% CI = 1·00-1·09, P-value = 0·04), while spouses were at no increased risk (HR = 0·99; 95% CI = 0·87-1·12). The excess risk of IHD in coeliac first-degree relatives aged 40-59 years was 70/100,000 person-years.
Conclusion:
First-degree relatives to coeliac patients seem to be at an increased risk of IHD but the excess risk is so small that it has little clinical relevance.
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