title: Mucosal healing and the risk of ischemic heart disease or atrial fibrillation in patients with celiac disease; a population-based study.
abstract: BACKGROUND
  Patients with celiac disease (CD), characterized histologically by villous atrophy (VA) of the small intestine, have an increased risk of ischemic heart disease (IHD) and atrial fibrillation (AF), risks that persist for years after commencing the gluten-free diet. It is unknown whether persistent VA on follow-up biopsy, rather than mucosal healing, affects the risk of IHD or AF.
  
  
  METHODS
  We identified patients with histologic evidence of CD diagnosed at all 28 pathology departments in Sweden. Among patients who underwent a follow-up small intestinal biopsy, we compared patients with persistent VA to those who showed histologic improvement, with regard to the development of IHD (angina pectoris or myocardial infarction) or AF.
  
  
  RESULTS
  Among patients with CD and a follow-up biopsy (n = 7,440), the median age at follow-up biopsy was 25 years, with 1,063 (14%) patients who were ≥ 60 years at the time of follow-up biopsy. Some 196 patients developed IHD and 205 patients developed AF. After adjusting for age, gender, duration of CD, calendar period, and educational attainment, there was no significant effect of persistent VA on IHD (adjusted HR 0.97; 95%CI 0.73-1.30). Adjusting for diabetes had a negligible effect (adjusted HR 0.98; 95%CI 0.73-1.31). There was no significant association between persistent VA and the risk of AF (adjusted HR 0.98; 95%CI 0.74-1.30).
  
  
  CONCLUSIONS
  In this population-based study of patients with CD, persistent VA on follow-up biopsy was not associated with an increased risk of IHD or AF. Failed mucosal healing does not influence the risk of these cardiac events.
authors: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States of America; Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Swede0060045.
authors: Benjamin
authors: B
authors: Lebwohl
authors: Primary care research unit, Vårdcentralen Värmlands Nysäter, Värmland County, and the Department of Medicine, Örebro University, Örebro, Sweden.
authors: Louise
authors: L
authors: Emilsson
authors: Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
authors: Ole
authors: O
authors: Fröbert
authors: Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, United States of America.
authors: Andrew J
authors: AJ
authors: Einstein
authors: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States of America.
authors: Peter H R
authors: PH
authors: Green
authors: Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Swede0060045; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
authors: Jonas F
authors: JF
authors: Ludvigsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology*; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000453:epidemiology*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014945:Wound Healing; D055815:Young Adult
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