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Diet-Dependent and Diet-Independent Hemorheological Alterations in Celiac Disease: A Case-Control Study
Zsolt Szakács1,2, Beáta Csiszár2,3, Mátyás Nagy1
1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
Insights
Celiac disease (CeD) patients exhibit altered blood flow properties (hemorheology), increasing cardiovascular risk. These changes can be diet-dependent or independent, highlighting the need for preventative strategies.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Gastroenterology
Background:
- Hemorheology, the study of blood flow, is crucial for cardiovascular health.
- Celiac disease (CeD) is linked to potential cardiovascular risks.
- Understanding hemorheological profiles in CeD is essential for risk assessment.
Purpose of the Study:
- To comprehensively assess hemorheological parameters and natural anticoagulant profiles in celiac disease patients.
- To investigate the influence of diet adherence on hemorheological status in CeD.
- To identify potential contributors to elevated cardiovascular risk in CeD.
Main Methods:
- A case-control study comparing 100 CeD patients with matched controls.
- Measurement of erythrocyte deformability, aggregation, and viscosity.
- Assessment of natural anticoagulants (protein C, S, antithrombin) and urine gluten immunogenic peptide (GIP).
Main Results:
- Impaired erythrocyte deformability at high shears was observed in CeD patients, independent of serology or urine GIP.
- Erythrocyte deformability at low shears was impaired in CeD patients with positive urine GIP.
- Prothrombotic hemorheological changes were more pronounced in CeD patients with poor dietary adherence.
Conclusions:
- Celiac disease is associated with both diet-dependent and independent prothrombotic hemorheological alterations.
- These hemorheological changes may contribute to the increased cardiovascular risk observed in CeD.
- Potential implementation of preventative strategies is suggested, considering metabolic changes during gluten-free diet.
Introduction:
Hemorheology is the study of the flow properties of the blood and its elements, which, together with natural anticoagulants, are important determinants of cardiovascular events. This study aimed to assess hemorheological and natural anticoagulant profiles of patients with celiac disease (CeD) comprehensively.
Methods:
Our study is a case-control study (registered under ISRCTN49677481) comparing patients with CeD with age- and sex-matched control subjects (1:1). We measured erythrocyte deformability (ED) at high (3-30 Pa) and low shears (0.3-3 Pa), erythrocyte aggregation, whole blood viscosity, plasma viscosity, and natural anticoagulants (protein C, protein S, and antithrombin activity). Adherence to gluten-free diet was estimated through dietary interview and urine gluten immunogenic peptide (urine GIP) detection.
Results:
After matching, we analyzed the data of 100 study participants. ED at high shears was impaired in CeD (P < 0.05 for all shears, confirmed by random forest analysis) independently of findings on CeD-specific serological assessment and urine GIP detection but slightly dependently on dietary adherence (P = 0.025 for 30 Pa shear). ED at low shears seemed to be impaired only in urine GIP+ CeD patients (P < 0.05 for all comparisons with urine GIP- CeD patients and control subjects). All parameters describing erythrocyte aggregation and whole blood viscosity were shifted toward a prothrombotic direction in patients with CeD with poor dietary adherence compared with those with good dietary adherence. Plasma viscosity and activity of natural anticoagulants did not differ across groups.
Discussion:
We observed diet-dependent and diet-independent prothrombotic hemorheological alterations in CeD, which can contribute to the elevated cardiovascular risk. The untoward metabolic changes during gluten-free diet, which can further aggravate hemorheological status, may indicate the implementation of prevention strategies.(Equation is included in full-text article.).
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