The Evaluation of Endothelial Functions in Patients with Celiac Disease

Aim: Celiac disease is characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine after the ingestion of wheat gluten or related rye and barley proteins. This study aimed to identify individuals who are at risk of heart failure and increased risk for cardiovascular events by evaluating endothelial function in patients with celiac disease. Materials and Methods: The study included 36 patients with celiac disease and 35 healthy volunteers. After all routine laboratory examination, left ventricular functions were evaluated with standard two‐dimensional, M‐mode conventional Doppler methods. Then, flow‐mediated dilatation and nitroglycerin‐dependent dilatation tests on brachial artery were performed to all patients and controls. Results: A total of 36 celiac patients and 35 healthy volunteers were included in the study. The brachial artery diameter at baseline was similar between both groups. Measured brachial artery diameter after hyperemia was 30.19 ± 4.47 mm in celiac patients and 32.35 ± 3.77 mm in the control group. Differences between two groups were statistically significant (P = 0.031). Flow‐mediated vasodilatation was lower in celiac patients compared with in controls (10.61 ± 2.64% vs 13.09 ± 2.9%; P = 0.0003). Measured endothelium‐independent vasodilatation in the brachial artery before and after nitroglycerin was similar between both groups (P = 0.09 and P = 0.07, respectively). Conclusion: This research which aimed to evaluate endothelial dysfunction in patients with celiac disease is the first in the literature. As a result of this study, we found endothelial dysfunction at the macrovascular level in celiac patients. (Echocardiography 2012;29:471‐477)

[1]  I. Roifman,et al.  Evidence of endothelial dysfunction in patients with inflammatory bowel disease. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[2]  A. Çelebi,et al.  Cardiac functions in children with coeliac disease during follow-up: insights from tissue Doppler imaging. , 2008, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[3]  W. Lai,et al.  Reactive hyperemic pre-ejection shear stress of brachial artery determines endothelial function in patients with untreated essential hypertension. , 2007, International journal of cardiology.

[4]  G. McVeigh,et al.  Microcirculatory Hemodynamics and Endothelial Dysfunction in Systemic Lupus Erythematosus , 2006, Arteriosclerosis, thrombosis, and vascular biology.

[5]  A. Gnasso,et al.  Effects of iodinated contrast media on common carotid and brachial artery blood flow and wall shear stress , 2006, European Radiology.

[6]  W. Caspary,et al.  Celiac disease , 2006, Orphanet journal of rare diseases.

[7]  D. Levy,et al.  Cross-Sectional Relations of Multiple Biomarkers From Distinct Biological Pathways to Brachial Artery Endothelial Function , 2006, Circulation.

[8]  E. Lonn,et al.  Relationship between carotid artery intima-media thickness and brachial artery flow-mediated dilation in middle-aged healthy men. , 2005, Journal of the American College of Cardiology.

[9]  D. Levy,et al.  Local Shear Stress and Brachial Artery Flow–Mediated Dilation: The Framingham Heart Study , 2004, Hypertension.

[10]  A. Gnasso,et al.  Wall Shear Stress Is Associated With Intima-Media Thickness and Carotid Atherosclerosis in Subjects at Low Coronary Heart Disease Risk , 2004, Stroke.

[11]  M. Curione,et al.  Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance. , 2002, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[12]  J. Keaney,et al.  Endothelial function: a barometer for cardiovascular risk? , 2002, Circulation.

[13]  A. Maseri,et al.  Celiac Disease Associated With Autoimmune Myocarditis , 2002, Circulation.

[14]  M. Curione Dilated cardiomyopathy and celiac disease. , 2002, Italian heart journal : official journal of the Italian Federation of Cardiology.

[15]  Ali Keshavarzian,et al.  Intestinal Permeation and Gastrointestinal Disease , 2002, Journal of clinical gastroenterology.

[16]  E. Benjamin,et al.  Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. , 2002, Journal of the American College of Cardiology.

[17]  G. Mancia,et al.  Radial Artery Flow-Mediated Dilatation in Heart Failure Patients: Effects of Pharmacological and Nonpharmacological Treatment , 2001, Hypertension.

[18]  S. Kadakia,et al.  The prevalence of celiac disease autoantibodies in patients with systemic lupus erythematosus , 2001, American Journal of Gastroenterology.

[19]  M. Curione,et al.  Prevalence of coeliac disease in idiopathic dilated cardiomyopathy , 1999, The Lancet.

[20]  A. Gnasso,et al.  In vivo association between low wall shear stress and plaque in subjects with asymmetrical carotid atherosclerosis. , 1997, Stroke.

[21]  D. Celermajer,et al.  Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. , 1994, Journal of the American College of Cardiology.

[22]  T. Reunala,et al.  Coeliac disease--associated disorders and survival. , 1994, Gut.

[23]  C. Mulder,et al.  Intestinal permeability in patients with coeliac disease and relatives of patients with coeliac disease. , 1993, Gut.

[24]  R Gorlin,et al.  Study of left ventricular geometry and function by B-scan ultrasonography in patients with and without asynergy. , 1974, The New England journal of medicine.

[25]  M. Bardella,et al.  Antiendomysial antibodies in patients with end-stage heart failure , 2002, American Journal of Gastroenterology.

[26]  H. Haber,et al.  Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study) , 2000, Journal of the American College of Cardiology.

[27]  A. Gnasso,et al.  NIDDM is associated with lower wall shear stress of the common carotid artery. , 1999, Diabetes.