title: Cardiovascular disease in patients with coeliac disease: A systematic review and meta-analysis.
abstract: BACKGROUND
  Coeliac disease has been associated with an increased risk of cardiovascular disease in some studies, whereas other studies have shown no association. We performed a systematic review and meta-analysis of cardiovascular disease in celiac disease.
  
  
  METHODS
  Pubmed, Cinahl, EMBASE and Medline via Ovid were searched for relevant articles published until January 5, 2015. English-language articles on studies with more than 20 patients were included, and were quality rated using the GRADE risk of bias tool. We used random-effects models and assessed heterogeneity using the I(2) statistic.
  
  
  RESULTS
  Ten studies were relevant, reporting the risk of myocardial infarction, cardiovascular death and stroke in 33,128/32,903/32,466 coeliac disease patients respectively. Only one study examined celiac disease and a composite measure of cardiovascular disease and this study found a hazard ratio of 1.10 (95%CI 1.03-1.28). In a meta-analysis, we observed an increased risk of stroke (OR 1.11; 95%CI 1.02-1.20). The risks of myocardial infarction (OR 1.12; 95%CI 0.83-1.40) and cardiovascular death (OR 1.12; 95%CI 0.96-1.29) were similar but were estimated with less certainty. Heterogeneity was low for all outcomes except for myocardial infarction where it was moderate.
  
  
  CONCLUSIONS
  Coeliac disease was associated with a modestly increased risk of cardiovascular disease, but the evidence base is limited.
authors.affiliation: Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway. Electronic address: lojsankik@hotmail.com.
authors.forename: Louise
authors.initials: L
authors.lastname: Emilsson
authors.affiliation: Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.affiliation: Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality; D002423:Cause of Death; D002446:Celiac Disease / Q000150:complications*; D006801:Humans; D012307:Risk Factors
keywords: Cardiovascular disease; Celiac; Coeliac; Meta-analysis