Vascular disease in a population-based cohort of individuals hospitalised with coeliac disease

OBJECTIVES: To evaluate the risk of cardiovascular disease in individuals with coeliac disease (CD). DESIGN: Swedish national hospital-based register data were used to identify 13,358 individuals who had been diagnosed with CD (1964-2003) and 64,118 age-matched and sex-matched individuals without CD. Cox regression was used to estimate the risk of vascular disease in subjects with CD. Analyses were restricted to individuals with a follow-up of >1 year and with no vascular disease before study entry. RESULTS: CD was associated with myocardial infarction (HR 1.27; 95% CI 1.09 to 1.48), angina pectoris (1.46; 1.25 to 1.70), heart failure (1.41; 1.22 to 1.62), brain haemorrhage (1.40; 1.05 to 1.88) and ischaemic stroke (1.35; 1.14 to 1.60). These risk estimates were similar when analyses were restricted to adults in whom vascular disease had been listed as the main diagnosis. In post-hoc analyses, where reference individuals were restricted to inpatients, no association was found between CD and later vascular disease, except for a lower risk of heart failure (0.79; 0.68 to 0.92). CONCLUSIONS: The positive association between CD and later vascular disease may be explained by ascertainment bias.