Introduction: Celiac disease (CD) is a common and underdiagnosed immune-mediated systemic disorder triggered by dietary gluten with a strong genetic component and various manifestations. Few studies in the literature examine the relationship of CD to cardiac pathology such as dilated cardiomyopathy (DCM), myocarditis (MC), and pericarditis. The potential links between CD and these cardiac pathologies are numerous and include systemic inflammation, imbalanced nutrition, auto-immune contribution, and potential shared genetic predisposition. We aimed to describe these associations using a large healthcare database.
Methods: We queried IBM Explorys® (Cleveland, OH), a database aggregating approximately 81 million patients drawn since 1999 from across the United States. Employing SNOMED Clinical Terms® definitions, we described patients with DCM, idiopathic myocarditis, and pericarditis, excluding those with clear secondary diagnoses such as infection and lupus. Multivariate regression analysis was performed using IBM SPSS Statistics® v26 (Chicago, IL). The analysis accounted for celiac disease as well as demographic variables and potential confounders, including age, gender, hypertension, obesity, diabetes, alcohol abuse and tobacco use.
Results: Of 80,920,060 patients included in the database (including 143,330 CD patients, or 0.18%), 848,960 were diagnosed with DCM (3,940 / 0.46% CD), 27,390 with idiopathic myocarditis (180 / 0.65% CD) and 63,990 with idiopathic pericarditis (460 / 0.71% CD). After running the multivariate regression analysis, CD was significantly associated with DCM (OR 1.56, 95%CI 1.50-1.60, p< 0.001), idiopathic myocarditis (OR 3.49, 95%CI 3.02-4.04, p< 0.001), and idiopathic pericarditis (OR 3.65, 95%CI 3.32-3.40, p< 0.001).
Discussion: After adjusting for potential confounders, CD was significantly associated with occurrence of DCM, idiopathic myocarditis, and pericarditis as represented in this large United States healthcare database. This finding may have clinical implications for CD patients who present with chest discomfort or those controlled on a gluten-free diet with new concerns of upper abdominal or lower chest discomfort.
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