The Relationship between Spontaneous Multi-Vessel Coronary Artery Dissection and Celiac Disease

Abstract

Celiac disease (CD) is an immune-mediated enteropathy involving the small intestines. Genetic and environmental risk factors as well as autoimmunity have been linked to its etiology. Studies have shown that coronary artery disease, autoimmune myocarditis, arrhythmias and premature atherosclerosis are more prevalent in individuals with CD compared to individuals without the disease. In this case report a young male patient with CD presented with acute myocardial infarction with spontaneous coronary artery dissections of two vessels. To the best of our knowledge, this is the first case report of spontaneous multi-vessel coronary artery dissection in a patient with CD.

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

“…Laboratory evaluation for inflammatory or autoimmune conditions is generally low yield but may be considered in the post-MI setting, particularly in patients who have symptoms of or physical examination findings of autoimmune or rheumatologic disease. SCAD has been described in case reports of patients with various systemic inflammatory diseases, including systemic lupus erythematosus, 97–102 inflammatory bowel disease, 103 polyarteritis nodosa, 104 sarcoidosis, 52 celiac disease, 105 and cryoglobulinemia in the setting of hepatitis C. 106 In these series, underlying coronary vasculitis 100 or systemic inflammation 100 may have contributed to the risk of SCAD, and larger cohort studies have shown that at least a small proportion of patients have either underlying inflammatory diseases or short-term increases in inflammatory markers. 13,60 Taken together, these series indicate that underlying inflammatory conditions may be predisposing factors in the development of SCAD in a small proportion of patients.…”

Cardiovascular involvement in celiac disease

“…In adult CD patients lacking cardiovascular risk factors, abnormal homocysteine, erythrocyte sedimentation rate, C-reactive protein, and insulin levels may, along with inflammation, be contributive to arterial stiffening[ 9 ]. Spontaneous coronary artery dissections have been observed as a cause of acute myocardial infarction in CD patients[ 3 ]. There is also some support for an association between CD and cerebrovascular disease[ 13 ].…”

“…Acute myocardial infarction with ST-elevation and spontaneous coronary artery dissection can occur in young patients with CD[ 3 , 136 ]. However, chronic hypocalcemia in untreated CD patients due to poor absorption of minerals can result in electrocardiographic changes that mimic acute myocardial infarction[ 120 ].…”

“…CD is of special interest among chronic diseases due to several factors: (1) it is associated with specific comorbidities; (2) it involves a compromised absorption of nutrients; and (3) a gluten-free diet (GFD) is currently the main long-term treatment[ 2 ]. Studies have shown that certain cardiovascular maladies, including cardiomyopathy, myocarditis, arrhythmias, and premature atherosclerosis, are more prevalent in individuals with CD as compared to individuals without the disease[ 3 , 4 ]. In this article, published works concerning the effects of CD on the cardiovascular system, and the risk of cardiovascular disease, are reviewed.…”

A Novel Biomarker for Prediction of Atrial Fibrillation Susceptibility in Patients with Celiac Disease

“…CD causes a number of gastrointestinal problems, such as diarrhea, abdominal distention and malabsorption, due to the intake of grain proteins, which are collectively referred to as a "gluten" diet [1,2]. Cardiovascular symptoms, like arrhythmias or irregular heartbeats, coronary artery diseases, and possible heart failure, have also been also reported to be associated with CD [2][3][4][5][6]. Some studies have indicated that these symptoms are caused by inflammation, while others have suggested the involvement of the autoimmune system response [7][8][9][10].…”