People with celiac disease may be more likely to develop heart disease despite having fewer traditional heart risks than other folks.

Celiac disease is an immune reaction that occurs when some people eat gluten, a protein found in wheat, barley and rye. The only treatment is following a strict gluten-free diet.

People with celiac disease may be 27% more likely to develop heart disease compared with those without this autoimmune condition, and the longer a person has celiac disease, the higher the risk, a new study suggests.

“People with celiac disease have an increased risk of heart disease that is independent of traditional risk factors, such as high blood pressure and cholesterol levels,” said study author Megan Conroy, an epidemiologist at the University of Oxford in the United Kingdom.

The new study wasn’t designed to say how, or even if, celiac disease raises the risk for heart attack and stroke, but researchers do have some theories.

“The increased risk could be due to inflammation in those with celiac disease as is seen in people with other autoimmune diseases, or it is linked in some way to consuming a gluten-free diet; however, without further research, we cannot say,” Conroy said.

Until more is known about this link, people with celiac disease should follow recommendations for a healthy heart and see their doctor if they have any concerns, she said.

For the study, researchers used data from the UK Biobank (a database of genetic and health information from a half-million people in England, Scotland and Wales) to see if there was a link between celiac disease and heart disease that was influenced by traditional heart risks.

Slightly more than 2,080 people had celiac but no signs of heart disease when the study began.

The researchers tracked their heart health through hospital records and death certificates for more than 12 years. During this time, nearly 41,000 people were diagnosed with heart disease, including about 220 with celiac disease. That’s equivalent to an annual heart disease rate of 9 in every 1,000 people with celiac disease compared to 7.4 in 1,000 without celiac.

The longer a person had celiac disease, the higher their risk for heart disease, the study found. People who’d had celiac disease for fewer than 10 years had a 30% increased risk for heart trouble. That rose to 34% among those who’d had celiac disease for a decade or more.

People with celiac disease had fewer known risk factors for heart disease, including excess weight or obesity, high cholesterol, high blood pressure and a history of smoking. Compared to folks without celiac disease, they were also more likely to have ideal heart risk scores based on smoking status, physical activity, total cholesterol levels, diabetes status, blood pressure and body mass index (BMI, an estimate of body fat based on height and weight).

People with celiac disease and an ideal cardiac risk score had a 60% greater risk for heart disease compared with those with an ideal risk score but no celiac disease.

The findings were published online Jan. 30 in BMJ Medicine.

This isn’t the first study to suggest a link between celiac disease and heart disease, said Dr. Peter Green, director of the Celiac Disease Center at Columbia University in New York City.

“People with celiac disease have lower traditional heart disease risk factors including low cholesterol, lower blood pressure, tend not to smoke, and have lower body mass indexes, but they have increased risk for heart disease,” he said.

There are many theories about the link between the two conditions, he said.

The chronic, simmering inflammation that occurs in autoimmune diseases like celiac is also a risk for heart disease, said Green, who reviewed the findings.

“People who have chronic inflammation for a long time prior to a diagnosis of celiac disease may remain inflamed because they don’t heal fully,” he explained.

People with celiac disease may also have low levels of “good” high-density lipoprotein, he noted.

What’s more, Green said, the treatment for celiac disease is to avoid eating gluten, which can be a double-edged sword when it comes to heart disease risk.

“People who don’t eat gluten don’t eat whole grains, which are cardioprotective,” he added.

His best advice?

See a dietitian regularly to learn how to eat a healthy and varied diet with celiac disease. “It’s not just what to avoid that is important,” Green said.

More information

Learn more about celiac disease at the Celiac Disease Foundation.

SOURCES: Megan Conroy, DPhil, epidemiologist, UK Biobank, University of Oxford, England; Peter Green, MD, director, Celiac Disease Center, Columbia University, New York City; BMJ Medicine, Jan. 30, 2023, online