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Gluten-free diet may mitigate elevated atherosclerosis risk in celiac disease
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Patients with celiac disease may be more likely to develop early atherosclerosis, but a gluten-free diet has the potential to mitigate this increased risk, according to recent results.
In a pilot study, researchers assessed the risk for atherosclerosis in 20 adults with celiac disease, at diagnosis and after 6 to 8 months of a gluten-free diet with mucosal recovery. Evaluated factors included total, HDL and LDL cholesterol, C-reactive protein (CRP), folate, vitamin B12, triglycerides and homocysteine. Carotid intima-media thickness (IMT) and endothelium-dependent dilation (EDD) also were measured via ultrasound at both time points and compared with measurements obtained from 22 matched healthy controls.
Patients had normal HDL and total cholesterol levels at baseline, while LDL levels were slightly elevated. Total and HDL cholesterol levels increased among patients after gluten abstinence (185.4 ± 37.77 mg/dL vs. 204.42 ± 35.2 mg/dL; P<.003 for total and 51.4 ± 18.6 mg/dL vs. 68.2 ± 17.4 mg/dL; P<.001 for HDL), with a decrease in total/HDL cholesterol ratio (3.77 ± 0.92 vs. 3.05 ± 0.71; P<.02). LDL concentrations did not significantly change within the cohort.
Mean levels of CRP decreased after gluten abstinence (1.073 ± 0.51 mg/dL vs. 1.92 ± 1.38 at baseline; P<.05). Plasma homocysteine levels, elevated among participants at baseline; triglycerides, folate and vitamin B12 levels were not significantly impacted by gluten abstinence.
Patients had higher IMT (0.082 ± 0.011 cm vs. 0.058 ± 0.012 cm; P<.005) and lower EDD (9.3 ± 1.3% compared with 11.2 ± 1.2%; P<.05) than controls at baseline, but showed improvement in both measurements after gluten-free diet (0.064 ± 0.01 cm, IMT; P<.03 for difference; and 12.1 ± 2.3%, EDD; P=.05 for difference).
“Our pilot study raises concerns on potentially increased cardiovascular risk in celiac disease secondary to accelerated atherosclerosis and unfavorable biochemical profile,” the researchers concluded. “Normalization of the small bowel mucosa due to gluten withdrawal seems to be associated with a beneficial effect, but further, larger studies are warranted to better define cardiovascular risk factors in celiac disease and potential positive modification induced by gluten abstinence.”
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