Women with common autoimmune inflammatory diseases face a significantly higher risk of dying from heart-related complications compared to their male counterparts, according to new research from the Cleveland Clinic.
The study, published May 5 in the journal Circulation: Cardiovascular Quality and Outcomes, found that women with rheumatoid arthritis, lupus, or systemic sclerosis have a 50% higher cardiovascular mortality rate than men with the same conditions.
"Our study highlights the significant burden of cardiovascular disease in patients with immune-mediated inflammatory diseases, which disproportionately affect women," said senior researcher Dr. Heba Wassif, director of cardio-rheumatology at the Cleveland Clinic.
Gender Disparities in Autoimmune Disease and Heart Risk
Women are already at higher risk of developing these autoimmune conditions, being two to three times more likely than men to develop rheumatoid arthritis and approximately nine times more likely to develop lupus. Systemic sclerosis, which involves the tightening and hardening of skin and can affect internal organs, is also more prevalent among women.
The research team analyzed data for more than 127,000 heart disease-related deaths among over 281,000 deaths associated with these three common autoimmune diseases between 1999 and 2020. Their findings revealed that while overall cardiovascular mortality has declined for both genders, a significant disparity persists.
Heart disease death rates for people with these autoimmune disorders decreased from 3.9 to 2.1 per 100,000 in women and from 1.7 to 1.2 per 100,000 in men during the study period. However, women consistently maintained higher mortality rates throughout.
Specific Cardiovascular Risks
The study identified stroke and arterial disease as the main causes of heart-related death in autoimmune patients, with women dying from both at higher rates than men. Perhaps most concerning, women were more than twice as likely to die from cardiac arrhythmias or cardiac arrest.
Among the three conditions studied, rheumatoid arthritis was associated with the highest cardiovascular mortality rate.
"There is a common perception that people with immune-mediated inflammatory diseases primarily die from infections or kidney disease," explained lead study author Dr. Issam Motairek, an internal medicine resident at Cleveland Clinic. "However, our study revealed that one-third of deaths in this population were due to cardiovascular disease, highlighting the significant burden of heart disease in these patients."
Women's Greater Vulnerability to Heart Risk Factors
This research aligns with another recent study scheduled for presentation at the American College of Cardiology, which found that lifestyle factors like diet, exercise, smoking, and blood pressure have a greater impact on women's heart health than men's.
That study, led by Dr. Maneesh Sud of Sunnybrook Health Sciences Center in Toronto, discovered that women with poor health have nearly five times the risk of heart disease compared to women with ideal health. By contrast, men in poor health only have 2.5 times the risk compared to men in ideal health.
"For the same level of health, our study shows that the increase in risk [related to each factor] is higher in women than in men — it's not one-size-fits-all," Dr. Sud noted.
Clinical Implications and Recommendations
The findings from both studies underscore the critical importance of early and aggressive cardiovascular risk management in women, particularly those with autoimmune conditions.
"It is critical to screen for and address cardiovascular risk factors early, at the time of diagnosis and periodically thereafter," Dr. Wassif emphasized.
The research highlights the need for healthcare providers to recognize that women with autoimmune inflammatory diseases represent a particularly high-risk population for cardiovascular complications. Standard risk assessment tools may underestimate their actual risk.
Dr. Motairek concluded, "This study reinforces the need to investigate drivers of these disparities between women and men and how to improve treatment for patients with immune-mediated inflammatory diseases."
Future Research Directions
Further research is needed to understand the biological mechanisms behind the increased cardiovascular vulnerability in women with autoimmune conditions. Potential factors may include hormonal influences, differences in immune system function, or variations in how inflammation affects the cardiovascular system in women versus men.
Additionally, developing gender-specific risk assessment tools and treatment protocols could help address these disparities and improve outcomes for women with autoimmune inflammatory diseases.
For now, experts recommend that women with rheumatoid arthritis, lupus, or systemic sclerosis should be particularly vigilant about cardiovascular health, working closely with their healthcare providers to monitor and manage traditional risk factors such as blood pressure, cholesterol, blood sugar, and lifestyle factors.
