Key result
Coeliac disease is linked to ~36% higher cardiovascular disease risk compared to matched controls.
Why the study?
Increased cardiovascular morbidity has been reported in coeliac disease, but little is known about this in dermatitis herpetiformis.
Does dermatitis herpetiformis or coeliac disease alter the risk of vascular diseases compared to the general population?
Cohort (n=5,736)
No
Does dermatitis herpetiformis or coeliac disease alter the risk of vascular diseases compared to the general population?
Hazard Ratio: 1.36 (95% CI 1.17–1.59)
Absolute Event Rate: 54.15% vs 38.52%
The vascular risk profile differs between phenotypes of coeliac disease, with classical coeliac disease increasing cardiovascular risk while dermatitis herpetiformis does not.
Coeliac phenotypes may warrant distinct vascular risk assessment; leaves open targeted prevention trials before practice change.
INTRODUCTION: Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Increased cardiovascular morbidity has been reported in coeliac disease, but in DH only little is known about this. In this cohort study with a long-term follow-up, the risk for vascular diseases in patients with dermatitis herpetiformis (DH) and coeliac disease was assessed. METHODS: The study consisted of 368 DH and 1072 coeliac disease patients with biopsy-proven diagnosis performed between 1966 and 2000. For each DH and coeliac disease patient three matched reference individuals were obtained from the population register. Data regarding all outpatient and inpatient treatment periods between 1970 and 2015 were reviewed for diagnostic codes of vascular diseases from the Care Register for Health Care. Cox proportional hazard model was used to assess the risks for the diseases studied and the HRs were adjusted for diabetes mellitus (aHR). RESULTS: The median follow-up time of DH and coeliac disease patients was 46 years. The risk for cardiovascular diseases did not differ between DH patients and their references (aHR 1.16, 95% CI 0.91-1.47), but among coeliac disease patients, the risk was increased (aHR 1.36, 95% CI 1.16-1.59). The risk for cerebrovascular diseases was found to be decreased in DH patients when compared with references (aHR 0.68, 95% CI 0.47-0.99) and increased in coeliac disease patients (aHR 1.33, 95% CI 1.07-1.66). The risk for venous thrombosis was increased in coeliac disease patients (aHR 1.62, 95% CI 1.22-2.16) but not in DH. CONCLUSIONS: The risk for vascular complications appears to differ between DH and coeliac disease. In DH the risk for cerebrovascular diseases seems to be decreased, while in coeliac disease an elevated risk for cerebrovascular and cardiovascular diseases was observed. These differing vascular risk profiles between the two manifestations of the same disease merit further investigation.
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Nilsson et al. (2023) conducted a cohort in Dermatitis herpetiformis and coeliac disease (n=5,736). Coeliac disease vs. Matched reference individuals from the general population was evaluated on Risk of cardiovascular diseases (aHR 1.36, 95% CI 1.17-1.59). Coeliac disease was associated with an increased risk for cardiovascular (aHR 1.36) and cerebrovascular diseases, whereas dermatitis herpetiformis was associated with a decreased risk for cerebrovascular diseases (aHR 0.68) compared to matched references.
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