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Coeliac disease increases AF risk

Atrial fibrillation (AF) is more common in patients diagnosed with coeliac disease (CD), though the excess risk is small, according to a study1 in a large cohort of patients with biopsy-verified CD published recently in the European Heart Journal.

Researchers led by Dr Louise Emilsson (Arvika Hospital, Sweden) identified 28,637 patients with CD through reports from biopsies performed between 1969 and 2008, from 28 pathology departments in Sweden.  141,731 age- and sex-matched reference individuals were identified from the Swedish Total Population Register.

In the CD cohort 941 individuals developed AF during a median follow-up of nine years, compared to 2,918 reference individuals. The corresponding adjusted hazard ratio for AF was 1.34, and 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.

Possible explanations for the increased risk of AF include chronic inflammation and shared risk factors, although ascertainment bias may also have contributed, say the authors.  They assert that “patients with coeliac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation…Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases such as coeliac disease”.

Professor Jonas F Ludvigsson

Professor Jonas F Ludvigsson

Senior author, Professor Jonas F Ludvigsson (Örebro University Hospital, Sweden), told Arrhythmia Watch: “Although we believe that coeliac disease is associated with an excess risk of atrial fibrillation we do not suggest mandatory cardiovascular screening [for AF].

“But I think that our findings illustrate that inflammation/autoimmune disease may increase the risk of AF…in patients with CD it is reasonable to have an increased awareness of symptoms that might indicate AF,” he added.

References

1 Emilsson L, Smith JG, West J, Melander O, Ludvigsson JF.  Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study.  Eur Heart J 2011 (online).  doi: 10.1093/eurheartj/ehr167

Published on: November 3, 2011

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