Carotid intima-media thickness and arterial stiffness as early markers of atherosclerosis in pediatric celiac disease

Abstract

The association between pediatric celiac disease (CD) and atherosclerosis is unknown. Our aim was to investigate whether pediatric CD patients have an increased risk of atherosclerosis. We evaluated the premature atherosclerosis by pulse wave velocity (PWV) and carotid intima-media thickness (cIMT). A total of 37 CD patients (20 girls, mean age 13±3.3 years) and 36 healthy age and sex matched controls were enrolled. Mean duration of CD was 47.1±32.3 months and 40.5% of patients had positive tissue transglutaminase antibody (tTg) IgA. Total cholesterol level was lower in CD (p=0.026) and cIMT was lower in tTg IgA antibody negative CD (p=0.030). cIMT was significantly correlated with tTg IgA antibody positivity (r=0.336; p=0.042). Adherence to strict gluten-free diet is associated with decreased cIMT, suggesting that gluten withdrawal seems to have a beneficial effect on premature atherosclerosis.

Cardiovascular involvement in celiac disease

“…Gluten avoidance followed by restoration of the intestinal villi to normal function is likely to revert cardiovascular dysfunction in less than 1 years’ time[ 2 , 20 , 21 , 23 , 24 ]. Areas with improved markers on a GFD include the common carotid arteries for intima media thickness, and the humeral artery for endothelium-dependent dilatation[ 26 ]. However, patients on the GFD often show weight gain and increase in triglyceride blood levels, which suggests a risk to atherogenicity[ 27 ], although alterations of other risk factors do not necessarily support this supposition[ 28 ].…”

“…There is an increased risk of ischemic heart disease and higher cardiovascular mortality in CD[ 145 , 146 ] despite the lack of traditional risk factors[ 26 , 147 ] including blood pressure, body mass index, serum cholesterol, lipids, exercise, and smoking[ 4 , 148 ]. First-degree relatives of CD patients are also at an increased risk of ischemic heart disease, but the excess risk is slight[ 149 ].…”

Review article: Systemic consequences of coeliac disease

“…The principles in the prevention and treatment of cardiovascular diseases in coeliac disease patients follow general recommendations 71 . The effect of a gluten‐free diet has been little studied, but there are some indications of a beneficial effect on carotid intima thickness and serum lipid profile, 61,72,73 as well as on cardiac performance in patients with cardiomyopathy 74 . Paradoxically, the diet may also increase the risk of cardiovascular events, as it often has poor fibre and mineral content and high levels of added sugar and fat 10,11,75,76 .…”

Celiac Disease

“…Ischemic heart disease-Untreated CeD is associated with an increased risk of atherosclerosis, even in childhood 191,192 . Altered cholesterol metabolism and inflammation (increased erythrocyte sedimentation rate, hyperhomocysteinemia) are cardiovascular risk factors that tend to improve on a GFD 191 ; however, there is limited evidence that an increased risk of incident ischemic heart disease persists for more than a year after CeD diagnosis 193,194 .…”