Vascular disease in a population-based cohort of individuals hospitalised with coeliac disease.
OBJECTIVE
To evaluate the risk of cardiovascular disease in individuals with coeliac disease (CD).


METHODS
Swedish national hospital-based register data were used to identify 13,358 individuals who had been diagnosed with CD (1964-2003) and 64,118 age-matched and sex-matched individuals without CD. Cox regression was used to estimate the risk of vascular disease in subjects with CD. Analyses were restricted to individuals with a follow-up of >1 year and with no vascular disease before study entry.


RESULTS
CD was associated with myocardial infarction (HR 1.27; 95% CI 1.09 to 1.48), angina pectoris (1.46; 1.25 to 1.70), heart failure (1.41; 1.22 to 1.62), brain haemorrhage (1.40; 1.05 to 1.88) and ischaemic stroke (1.35; 1.14 to 1.60). These risk estimates were similar when analyses were restricted to adults in whom vascular disease had been listed as the main diagnosis. In post-hoc analyses, where reference individuals were restricted to inpatients, no association was found between CD and later vascular disease, except for a lower risk of heart failure (0.79; 0.68 to 0.92).


CONCLUSIONS
The positive association between CD and later vascular disease may be explained by ascertainment bias.
Ludvigsson
J F
JF
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. jonasludvigsson@yahoo.com
de Faire
U
U
Ekbom
A
A
Montgomery
S M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D012042:Registries; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013548:Sweden / Q000453:epidemiology