Scott Buzby , 2025-05-15 14:00:00
Key takeaways:
- CVD mortality for patients with autoimmune disease decreased since 1999.
- Despite lower risk over time, the rate of CV death among women remained higher vs. men.
Fewer patients with autoimmune disease are dying due to cardiovascular disease, but women remain at higher risk vs. men, according to data published in Circulation: Cardiovascular Quality and Outcomes.
“Cardio-rheumatology is an important area and our knowledge about it is expanding every day. The whole field has grown in the last 5 years in a way I never expected, but it’s a much needed sub-subspecialty of cardiology, to bridge the gap and care for these patients,” Heba S. Wassif, MD, MPH, cardiologist and director of inpatient clinical cardiology in the Tomsich Family Department of Cardiovascular Medicine at the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, told Healio. “There have been a lot of discussions and a lot of papers published about CV risk in autoimmune disorders. There are a lot of observational studies looking at the impact of medications on CV outcomes, but the majority of them are published in noncardiology journals.”
Heba S. Wassif
To better understand CVD mortality among people with underlying immune-mediated inflammatory diseases, Wassif and colleagues evaluated CVD deaths within the U.S. from 1999 to 2020 using data from the CDC Multiple Cause of Death files. Inflammatory diseases of interest included rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.
Autoimmune disorders and CV death
Overall, 127,149 CVD-related deaths among 281,355 immune-mediated inflammatory disease-related deaths were evaluated.
The researchers reported that from 1999 to 2020, age-adjusted mortality rates for women with immune-mediated inflammatory disease decreased from approximately 3.3 to 1.4 per 100,000 people, whereas for men, rates dropped from 2.3 to 1.1 per 100,000 people (P < .01).
During that time, age-adjusted mortality remained significantly higher for women vs. men with immune-mediated inflammatory disease (RR = 1.5; 95% CI, 1.4-1.6; P < .01), with ischemic heart disease and cerebrovascular disease being the largest contributors to CVD death.
The difference in mortality rates between men and women with rheumatoid arthritis was the largest among the diseases studied, with rates of 1.8 per 100,000 observed in women vs. 0.6 per 100,000 for men, a difference the researchers reported to persist through 2020.
Women with systemic lupus erythematosus experienced stable mortality rates over time, at around 0.2 per 100,000 people, which was slightly higher compared with men, at 0.1 per 100,000 people.
Event rates for men with systemic sclerosis were low, leading to censored data, according to the study.
Assess CV risk early
“This study points out that, yes, there have been improvements. Patients with autoimmune disorders are dying from CVD, not from infection. One-third of these patients died from CVD. That is not trivial,” Wassif told Healio. “It is positive in a way that we’re seeing a decrease in mortality over time, but we’re seeing a gap between men and women. We’ve always known there is a gap, even in the general population, between men and women.
“The idea is that we need to be aware. If you see a patient with an autoimmune disorder and their CV risk has not been evaluated, it needs to be evaluated,” Wassif said. “This is a multilayered approach to these patients and the cardiologist is only at the far end. CV care needs to be started from primary care and from rheumatology before they even get to the cardiologist.”
