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Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study

Emilsson, Louise; Smith, Gustav LU ; West, Joe; Melander, Olle LU and Ludvigsson, Jonas F. (2011) In European Heart Journal 32(19). p.2430-2437
Abstract
Aims Inflammatory markers are established risk factors for atrial fibrillation (AF), but the role of autoimmune diseases is unknown. The aim of the study was to examine the association between coeliac disease (CD) and AF in a large cohort of patients with biopsy-verified CD. Methods and results We identified 28 637 patients with CD through biopsy reports (defined as Marsh 3: villous atrophy) from all pathology departments (n = 28) in Sweden. Biopsies had been performed between 1969 and 2008. Age-and sexmatched reference individuals (n = 141 731) were identified from the Swedish Total Population Register. Data on AF were obtained from the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register.... (More)
Aims Inflammatory markers are established risk factors for atrial fibrillation (AF), but the role of autoimmune diseases is unknown. The aim of the study was to examine the association between coeliac disease (CD) and AF in a large cohort of patients with biopsy-verified CD. Methods and results We identified 28 637 patients with CD through biopsy reports (defined as Marsh 3: villous atrophy) from all pathology departments (n = 28) in Sweden. Biopsies had been performed between 1969 and 2008. Age-and sexmatched reference individuals (n = 141 731) were identified from the Swedish Total Population Register. Data on AF were obtained from the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register. Hazard ratios (HRs) for AF were estimated using Cox regression. In the CD cohort, 941 individuals developed AF (vs. 2918 reference individuals) during a median follow-up of 9 years. The corresponding adjusted HR for AF was 1.34 (95% CI 1.24-1.44). The absolute risk of AF in CD was 321 of 100 000 person-years, with an excess risk of 81 of 100 000. A prior AF diagnosis was also associated with an increased risk of subsequent CD (odds ratio 1.45, 95% CI 1.31-1.62). Conclusions Atrial fibrillation is more common both before and after CD diagnosis in patients with CD though the excess risk is small. Potential explanations for the increased risk of AF in CD include chronic inflammation and shared risk factors, but ascertainment bias may also have contributed. Clinical implications Coeliac disease affects 1-2% of the Western population. Our results indicate that patients with coeliac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation. This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases such as coeliac disease. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Autoimmunity, Coeliac, Inflammation, Atrial fibrillation
in
European Heart Journal
volume
32
issue
19
pages
2430 - 2437
publisher
Oxford University Press
external identifiers
  • wos:000295684300023
  • scopus:80054052563
ISSN
1522-9645
DOI
10.1093/eurheartj/ehr167
language
English
LU publication?
yes
id
d3a8c694-d6fb-4a26-aa4a-f634d23a56a8 (old id 2212818)
date added to LUP
2011-12-01 08:34:41
date last changed
2017-06-11 04:02:55
@article{d3a8c694-d6fb-4a26-aa4a-f634d23a56a8,
  abstract     = {Aims Inflammatory markers are established risk factors for atrial fibrillation (AF), but the role of autoimmune diseases is unknown. The aim of the study was to examine the association between coeliac disease (CD) and AF in a large cohort of patients with biopsy-verified CD. Methods and results We identified 28 637 patients with CD through biopsy reports (defined as Marsh 3: villous atrophy) from all pathology departments (n = 28) in Sweden. Biopsies had been performed between 1969 and 2008. Age-and sexmatched reference individuals (n = 141 731) were identified from the Swedish Total Population Register. Data on AF were obtained from the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register. Hazard ratios (HRs) for AF were estimated using Cox regression. In the CD cohort, 941 individuals developed AF (vs. 2918 reference individuals) during a median follow-up of 9 years. The corresponding adjusted HR for AF was 1.34 (95% CI 1.24-1.44). The absolute risk of AF in CD was 321 of 100 000 person-years, with an excess risk of 81 of 100 000. A prior AF diagnosis was also associated with an increased risk of subsequent CD (odds ratio 1.45, 95% CI 1.31-1.62). Conclusions Atrial fibrillation is more common both before and after CD diagnosis in patients with CD though the excess risk is small. Potential explanations for the increased risk of AF in CD include chronic inflammation and shared risk factors, but ascertainment bias may also have contributed. Clinical implications Coeliac disease affects 1-2% of the Western population. Our results indicate that patients with coeliac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation. This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases such as coeliac disease.},
  author       = {Emilsson, Louise and Smith, Gustav and West, Joe and Melander, Olle and Ludvigsson, Jonas F.},
  issn         = {1522-9645},
  keyword      = {Autoimmunity,Coeliac,Inflammation,Atrial fibrillation},
  language     = {eng},
  number       = {19},
  pages        = {2430--2437},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehr167},
  volume       = {32},
  year         = {2011},
}