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Known—but not newly diagnosed—celiac disease associates with lower cardiac troponin I levels, suggesting a potential cardioprotective effect of a gluten-free diet, while no relationship is observed with C-reactive protein.
A large population-based analysis from the Trøndelag Health Study (HUNT4) challenges concerns about heightened cardiovascular disease (CVD) risk in celiac disease (CeD), showing that individuals with established CeD have lower levels of cardiac troponin I (cTnI), a biomarker of subclinical myocardial injury.
CeD is an immune-mediated ailment induced by gluten ingestion, marked by transglutaminase (TG2) antibodies, small intestinal villous atrophy, and malabsorption. Although chronic inflammation in CeD has been proposed as a contributor to CVD, prior evidence has been inconsistent. High-sensitivity cTnI reflects subtle myocardial injury and predicts future CVD risk, while C-reactive protein (CRP) serves as a marker of systemic inflammation.
In this cross-sectional study, researchers measured CRP and circulating cTnI concentrations in 37,559 subjects (mean age 55 years; 45% male) from HUNT4. Volunteers underwent serological screening for CeD using TG2 IgA and IgG antibodies. Seropositive individuals without a prior diagnosis were invited for confirmatory endoscopy with duodenal biopsies. Volunteers were categorized into 4 groups:
The relationships between CeD status, CRP, and cTnI were checked through linear regression models. Participants with newly diagnosed CeD had lower median CRP compared with those without CeD (1.0 mg/L vs 1.3 mg/L). However, after full multivariable adjustment, CeD status was not independently related to CRP, indicating no clear link between CeD and systemic inflammation.
Median cTnI concentrations were lower in both newly diagnosed (1.5 ng/L) and known CeD (1.5 ng/L) compared with no CeD (1.7 ng/L). In fully adjusted models, however, only known CeD remained independently associated with lower cTnI levels (β −0.154). Neither newly diagnosed nor potential CeD exhibited independent associations with cTnI after adjustment. These findings suggest:
The selective association with known CeD raises the possibility that long-term adherence to a gluten-free diet may minimize subclinical myocardial injury, potentially lowering cardiovascular risk.
European Heart Journal
Celiac disease, systemic inflammation, and the risk of subclinical myocardial injury
J Young et al.
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