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Subject:
From:
L and N Matsui <[log in to unmask]>
Reply To:
L and N Matsui <[log in to unmask]>
Date:
Sat, 13 Jul 2002 16:03:04 +0000
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<<Disclaimer: Verify this information before applying it to your situation.>>

Common causes?
In a case study, similar cellular changes were found in both the intestinal
microvilli and the heart muscle of a patient who had both idiopathic
congestive cardiomyopathy and CD (Chuaqui B, et al, 1986, Pathol Res Pract
181:604).  While this was a limited study and the molecular causes of each
were not evaluated, it is an intriguing find.  In another case study, a CD
patient also had recurrent hemoptysis and developed heart block (Mah MW, et
al, 1989, Can J Cardiol 5:191).  The authors hypothesize that there is a
common cause of the symptoms above.  The cause is undefined by the authors.
Similarly, a patient who had chronic anemia, cardiomyopathy, and heart block
but did not have digestive symptoms was found to have anti-gliadin
antibodies (AGA), AEA, and anti-reticulin antibodies (ARA) as well as the
typical celiac biopsy (Rubio JLC, et al, 1998, Am J Gastroenterol 93:1391).
The authors found that after 1 year of GFD, blood tests and biopsy were
normal and confirm CD as a diagnosis; but they do not mention whether or not
the cardiomyopathy and heart block resolved.

CD and autoimmune myocarditis
In an Italian study, 187 patients, including 110 with heart failure and 77
with arrhythmias, diagnosed with myocarditis were tested for CD (Frustaci A,
et al, 2002, Circulation 105:2611).  Thirteen patients had IgA tissue
transglutaminase antibodies (tTGA); all had anemia.   Nine of the thirteen
were AEA-positive; these patients also had abnormal biopsies.  Thus, 4.4% of
myocarditis patients had CD (they compare this to 0.6% in the
non-myocarditis population; this was statistically significant.  Eight of
the nine myocarditis patients with CD had HLA DQ2-DR3, the other patient had
DQ2-DR5/DR7.  Five of the nine myocarditis patients with CD had heart
failure and were treated with immunosuppression and GFD.  The other four
myocarditis patients with CD had heart arrhythmias and were treated with
GFD.  All nine patients markedly improved in cardiologic features and were
tTGA- and AEA-negative post-treatment (8-12 months).

Other Cardiologic Diseases
CD and Ischemic heart disease
In a report made in 1976, celiac disease was associated with a decrease in
ischemic heart disease in 77 members of the Coeliac Society of England and
Wales (Whorwell PJ, et al, 1976, Lancet 2:113).  In another study with 653
CD patients, the authors found no decrease in ischemic heart disease or
stroke for CD patients (Logan RF, et al, 1989, Gastroenterology 97:265).  A
recent study examined the risk factors for ischemic heart disease in DH
patients (Lear JT, et al, 1997, J Royal Soc Med 90:247).  The authors found
that, compared to the normal population, DH patients had lower cholesterol,
lower triglycerides, lower apolipoprotein B, lower fibrinogen, higher HDL2,
smoked less, and were generally of higher social class.

Pericarditis
Dermatitis herpetiformis (DH) has also been found to be associated with
recurrent pericarditis (Afrasiabi R, et al, 1990, Chest 97:1006).  The
authors found IgG, IgA, and complement in the pericardium, thus
demonstrating similarities with the skin deposition of IgA in DH lesions.

Summary
While there hasn’t been a comprehensive review by a CD researcher, the
research papers summarize here point to a correlation of CD with
cardiomyopathy, heart arrhythmias, and heart failure.  The authors of the
articles summarized here often point to a probable association of autoimmune
disease in both CD and related heart diseases.

Glossary of terms:
Cardiomyopathy: aberrant heart muscle structure
Congenital: non-inherited, usually referring to what is considered a ‘birth
defect’
Heart block: blockage of the conduction of the heart electrical signaling
system which regulates the heart beat
Hemoptysis: spitting blood, usually due to lesions to the respiratory tract
or voice box
Idiopathic: often used to describe something whose origin is unknown
Ischemic heart disease: heart damage due to insufficient blood flow to the
heart (i.e., via the coronary arteries)
Myocarditis: inflammation of the heart muscle
Pericarditis: inflammation of the pericardium, a sac which encloses the
heart

Laura




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