STOCKHOLM, SWEDEN. A group of researchers from Karolinska Institute recently reported an association between gluten intolerance (celiac disease) and heart disease. Now the same group reports an association between celiac disease (CD) and atrial fibrillation. Their study involved 28,637 patients with biopsy-verified CD and 141,731 age- and sex-matched individuals free of CD as verified by biopsy of the small intestine. Biopsies were performed between 1969 and 2008 and study participants were followed for an average of 9 years. During follow-up, 941 individuals (3.2%) in the CD group developed atrial fibrillation (AF) as compared to 2,918 individuals (2.1%) in the control group.

Thus, having been diagnosed with CD was associated with a 34% increase (relative) in the risk of later being diagnosed with AF. The risk estimate did not change significantly when adjusted for the presence of type 1 diabetes, rheumatoid arthritis, thyroid disease, and hypertension. The researchers also noted an association between a prior diagnosis of AF and an increased risk (45% relative) of subsequently developing CD. The researchers conclude that their findings support a role of autoimmune disease in the development of AF, potentially acting through systemic inflammation. They also made the following interesting observations:

• Most CD diagnoses (41%) were made before the age of 19 years. Only 18% were diagnosed after age 60 years.
• The majority (62%) of CD patients were female.
• The majority of AF diagnoses were made within a year following confirmation of CD.
• It is possible that part of the reason for the increased number of AF diagnoses made in the year following CD diagnosis is due to ascertainment bias (patients likely received more medical attention after their CD diagnosis).

Emilsson, L, Ludvigsson, JF, et al. Increased risk of atrial fibrillation in patients with celiac disease: a nationwide cohort study. European Heart Journal, June 8, 2011 [Epub ahead of print]

Editor�s comment: This study once again confirms the association between systemic inflammation and AF. It, unfortunately, did not distinguish between heart disease-related AF and lone AF. However, other studies have confirmed an association between inflammation and lone AF. In view of the observation that AF is associated with a small increased risk of developing CD, it would seem prudent for afibbers to avoid gluten and to maintain an anti-inflammatory protocol based on natural supplements such as curcumin, bromelain, beta-sitosterol, boswellia, Zyflamend or Moducare.