title: Risk of stroke in 28,000 patients with celiac disease: a nationwide cohort study in Sweden.
abstract: BACKGROUND
  Earlier studies on stroke in celiac disease (CD) have been underpowered, but a recent study suggested that childhood CD is associated with a 10-fold increased risk of death from stroke, although it was based on small numbers. We examined the risk of stroke in patients with biopsy-verified CD.
  
  
  METHODS
  We collected biopsy data from all 28 pathology departments in Sweden and identified 28,676 individuals with CD diagnosed between 1969 and 2007 (Marsh 3: villous atrophy). In the main analyses, we used Cox regression to estimate hazard ratios (HRs) for stroke in patients with CD compared with HRs for stroke in 141,806 sex- and age-matched controls.
  
  
  RESULTS
  During follow-up, there were 785 first-stroke diagnoses in patients with CD and 2937 in reference individuals. Patients with CD were at increased risk of stroke (HR 1.10; 95% confidence interval [CI] 1.01-1.19). HRs were similar for ischemic stroke and brain hemorrhage and were not affected by adjustment for type 1 diabetes, rheumatoid arthritis, use of medication against hypertension, or dyslipidemia. The absolute risk of stroke in patients with CD was 267 per 100,000 person-years (excess risk 24/100,000). The highest risk estimates occurred in the first year, with virtually no increased risk after more than 5 years of follow-up after CD diagnosis. The HR for stroke in childhood CD was 1.10 (95% CI 0.37-3.22).
  
  
  CONCLUSIONS
  Patients with CD are at only a small increased risk of stroke, which persists only for a brief period after diagnosis. CD does not seem to be a major risk factor for stroke.
authors: Department of Pediatrics, Örebro University Hospital, Örebro, Sweden. jonasludvigsson@yahoo.com
authors: Jonas F
authors: JF
authors: Ludvigsson
authors: Joe
authors: J
authors: West
authors: Tim
authors: T
authors: Card
authors: Peter
authors: P
authors: Appelros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult