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Vascular disease in a population-based cohort of individuals hospitalised with coeliac disease
  1. J F Ludvigsson1,
  2. U de Faire2,
  3. A Ekbom1,
  4. S M Montgomery1
  1. 1Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
  2. 2Division of Cardiovascular Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to:
    Dr J F Ludvigsson
    Department of Paediatrics, Örebro University Hospital, Örebro 71994, Sweden; jonasludvigsson{at}


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.

  • AP, angina pectoris
  • CD, coeliac disease
  • DM, diabetes mellitus
  • ICD, International Classification of Diseases
  • MI, myocardial infarction
  • IPR, Inpatient Register
  • SEI, socioeconomic index

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  • Published Online First 3 February 2007

  • Funding: JFL was supported by grants from the Swedish Research Council and the Örebro University Hospital while writing this article. This project was supported by the Swedish Research Council, the Swedish Society of Medicine, the Örebro Society of Medicine, the Majblomman Foundation, the Sven Jerring Foundation, the Karolinska Institutet, The Clas Groschinsky Foundation, the Juhlin Foundation, the Stiftelsen Samariten and the Swedish Coeliac Society. The funding organisations played no role in the design or conduct of the study, in the collection, management, analysis or interpretation of the data, and did not participate in preparation, review or approval of the manuscript.

  • Competing interests: None.

  • JFL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.