The disparity of deaths between women and men was the most important in people with rheumatoid arthritis (RA) – women with PR were 3 times more likely to die of heart disease compared to men.
“Our study highlights the important burden on cardiovascular disease in people with inflammatory immune mediation diseases, which disproportionately affect women,” said the author of the main study Heba S. Wassif, MD, MPH, director of cardio-rheumatology at the Cleveland Clinic in Ohio.
Inflammatory immune mediation diseases are a subset of autoimmune conditions and include rheumatoid arthritis as well as Crohn’s disease, ulcerative colitis, psoriasis, asthma, multiple sclerosis and lupus.
Inflammation caused by autoimmune conditions can damage the heart
Although it is already established that chronic inflammation of autoimmune conditions can damage the heart, many people living with these conditions are not aware of their increased risk, explains Dr. Wassif.
Cardiovascular deaths have dropped over 20 years, but the gender gap remains
For this test, investigators focused on cardiovascular deaths between 1999 and 2020 in people with three conditions: rheumatoid arthritis, lupus and systemic sclerosis, also called scleroderma.
Out of more than 281,000 deaths linked to these diseases during this period, more than 127,000 were linked to cardiovascular causes.
“If you look at the data from the point of view of the” half-party “, the overall mortality rate linked to cardiovascular disease in this group has dropped by more than half,” said Wassif.
Deaths went from 3.9 to 2.1 per 100,000 women and from 1.7 to 1.2 per 100,000 men.
In other words, although the deaths of heart disease has dropped for everyone, the gap between the sexes has remained.
Although this is certainly good news that the overall number of cardiovascular deaths in these groups of people has dropped, the study really reveals a disturbing gap between women and men, explains Michael Garshich, MD, cardiologist and cardio-rheumatologist at Nyu Langone Health in New York, which was not involved in research.
“Interestingly, when the authors also examined sexual differences in deaths due to cancer, infection and respiratory diseases, there was much less disparity, or in some cases, there was an equal risk.
Why are women with autoimmune diseases more at risk?
Garish thinks that a large part of the gap may be that heart disease and its risk factors are under-reported and subcontracted in women.
“I think this is aggravated by the fact that women are registered less frequently in clinical trials, and there is therefore really a treatment gap in women in general,” he said.
Additional research is necessary to study the “why”, explains the Wassif. The higher number of deaths in women could also be linked to other diseases, access to treatment or differences in the way the symptoms arise, the authors wrote.
Management of autoimmune conditions and the risk of heart disease can improve results
It is likely that the downward trend for cardiovascular death is due to both the treatment of autoimmune diseases and cardiovascular treatments, the Wassif explains.
Biological therapies used to manage many autoimmune conditions can help reduce systemic inflammation, which means less damage to the heart.
Drugs such as statins and high blood pressure drugs have been shown to reduce the risk of early death due to events such as heart attack and stroke, authors wrote.
Do not take care of your heart health
A large lesson here is that all those who have an autoimmune condition – in particular women – should defend themselves to ensure that they get the help they need to manage cholesterol levels, blood pressure and other risk factors, explains Garshich.
People with autoimmune conditions often have many different doctors and health problems to manage, he underlines: “For this reason, the fight against cardiovascular risk can continue to be pushed to” the next meeting “, again and again, sometimes until it is too late.”
There can also be some hesitation because people are afraid of the side effects of certain drugs, explains Guyickk. “I tell my patients that there is no reason in 2025 that we cannot put you on an effective medication to reduce your cholesterol, treat your diabetes or manage your blood pressure that you can tolerate. We have so many good options to manage your risk factors, ”he says.
