Celiac Disease and Cardiovascular Disease: Epidemiology, Mechanisms, and Clinical Challenges

Celiac disease (CD), a chronic immune-mediated enteropathy triggered by gluten ingestion, is increasingly recognized as a systemic disorder with significant extraintestinal manifestations, including effects on the cardiovascular system. This review synthesizes recent epidemiological evidence demonstrating that individuals with CD face a modest but statistically significant increase in cardiovascular disease risk, including ischemic heart disease, myocardial infarction, and venous thromboembolism, despite a lower prevalence of traditional risk factors such as obesity, hypertension, and smoking. This so-called "risk factor paradox" underscores the significance of nontraditional, disease-specific mechanisms, including chronic systemic inflammation, immune dysregulation, nutritional deficiencies, and the metabolic consequences of a gluten-free diet. Emerging data also highlight the early onset of nontraditional cardiovascular risk in pediatric CD populations and the reversibility of some cardiac manifestations, such as arrhythmias and cardiomyopathy, with strict gluten-free diet adherence. Clinical recommendations now emphasize annual cardiovascular screening, comprehensive nutritional assessment, and multidisciplinary management in patients with CD. However, significant research gaps remain, including the need for CD-specific risk prediction tools, randomized trials on dietary quality, and greater understanding of genetic and autoimmune contributions to cardiovascular disease in CD. Addressing these gaps is essential for optimizing prevention and management strategies in this growing patient population.