A recent extensive study indicates that women suffering from common autoimmune diseases face more than double the cardiovascular mortality risk compared to their male counterparts. This can encompass severe conditions like coronary artery disease, arrhythmia, stroke, and heart attacks. Notably, the disparity is most pronounced among individuals with rheumatoid arthritis, where women are found to be three times more likely to succumb to heart disease than men.
“Our study highlights the significant burden of cardiovascular disease in people with immune-mediated inflammatory diseases, which disproportionately affect women,” explained Dr. Heba S. Wassif, MD, MPH, the study’s senior author and director of cardio-rheumatology at the Cleveland Clinic.
Immune-mediated inflammatory diseases, a subset of autoimmune conditions, include rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, asthma, multiple sclerosis, and lupus. Estimates suggest that between 24 and 50 million individuals in the United States are affected by autoimmune diseases, with women representing up to 80% of these cases.
Impact of Inflammation on Heart Health
Chronic inflammation associated with these autoimmune disorders is a known contributor to heart damage. Unfortunately, many individuals living with these conditions are often unaware of the heightened risk they face. A study encompassing over 22 million participants in the UK revealed that having one of 19 autoimmune conditions significantly increases the risk of developing heart disease, comparable to traditional risk factors such as smoking and type 2 diabetes.
It is crucial to note that cardiovascular disease encompasses a wide range of conditions affecting the heart and blood vessels, not just heart disease itself.
Trends in Cardiovascular Mortality
Focusing on cardiovascular deaths among those with rheumatoid arthritis, lupus, and systemic sclerosis (scleroderma), researchers found significant data over a period from 1999 to 2020. More than 281,000 deaths during this time were associated with these diseases, with over 127,000 deaths attributed to cardiovascular causes.
“From a positive perspective, the overall death rate related to cardiovascular diseases in these groups has decreased by more than half,” Dr. Wassif remarked. Specifically, the rates fell from 3.9 to 2.1 per 100,000 women and from 1.7 to 1.2 per 100,000 men. Nevertheless, the gender gap persists despite overall reductions in cardiovascular mortality.
“There’s a prevalent belief that individuals with immune-mediated inflammatory diseases primarily succumb to infections or kidney issues. However, our findings show that one-third of deaths in this demographic are due to cardiovascular disease, emphasizing the critical need to recognize heart disease in these patients,” noted Dr. Issam Motairek, MD, lead author of the study.
While the decline in cardiovascular deaths is encouraging, it highlights a concerning disparity between genders, as noted by Dr. Michael Garshick, a cardiologist affiliated with NYU Langone Health, who was not part of the study. “Interestingly, the data for cancer, infection, and respiratory illness exhibited far fewer gender differences, underscoring the unique outcomes related to cardiovascular issues,” he stated.
Understanding the Increased Risk for Women
The reasons behind the higher cardiovascular risk for women with autoimmune diseases remain unclear. Dr. Garshick attributes part of this gap to the underrecognition and undertreatment of heart disease and its risk factors in women. He remarked that women’s underrepresentation in clinical trials contributes to a treatment gap, necessitating further research to understand this disparity.
Improving Patient Outcomes Through Management
The study suggests that the declining trend in cardiovascular-related deaths could be attributed to advancements in both autoimmune disease management and cardiovascular treatments. Biologic therapies aimed at mitigating systemic inflammation may consequently protect cardiac health. Medications such as statins and drugs for hypertension have also demonstrated efficacy in reducing early death risks linked to heart attacks and strokes.
Prioritizing Heart Health
This research underscores the importance for all individuals with autoimmune diseases, particularly women, to actively engage in managing their heart health. Dr. Garshick emphasizes the necessity of advocating for oneself to monitor cholesterol levels, blood pressure, and additional cardiovascular risk factors.
Managing several health concerns can lead to neglect of cardiovascular risk among people with autoimmune conditions. As Dr. Garshick noted, addressing heart health frequently gets postponed until “the next appointment,” which sometimes results in delayed action. Additionally, hesitancy around potential medication side effects can prevent patients from seeking necessary treatments. “We have numerous effective options available in 2025 to manage cholesterol, diabetes, and blood pressure safely,” he affirmed.
