In high-income regions such as Europe and the United States, approximately ten percent of the population has been diagnosed with one or more autoimmune illnesses.

Some examples are psoriasis, lupus erythematosus, systemic sclerosis, and type I diabetes.

Even though some of these disorders have been linked to a higher risk of cardiovascular disease in the past, these studies were often too small and only looked at a few autoimmune or cardiovascular conditions to prove that people with autoimmune diseases should take steps to prevent cardiovascular disease.

Now. This weekend in Barcelona, at the annual meeting of the European Society of Cardiology, an international team of researchers led by KU Leuven presented the results of a thorough epidemiological study that looked into possible links between 19 of the most common autoimmune disorders and heart disease.

According to the study’s findings, individuals with autoimmune disease are far more likely than healthy individuals to develop cardiovascular disease (between 1.4 and 3.6 times higher risk depending on the autoimmune illness they have).

Similar to type 2 diabetes, which is a well-known risk factor for cardiovascular disease, this increased risk is comparable to it. The study demonstrates for the first time that autoimmune illness as a set of disorders is affected by cardiovascular risks rather than specific ailments individually.

The whole range of heart diseases

The authors of the study (which will be published in The Lancet) demonstrate that the 19 autoimmune illnesses they looked at account for around 6% of cardiovascular events.

Importantly, the increased risk of heart disease was seen in all types of heart disease, not just classic coronary heart disease.

This includes infection-related heart disorders, inflammation of the heart, thromboembolic heart disorders, and degenerative heart disorders.

This suggests that the effects of autoimmunity on heart health are likely to be much broader than was thought before. In addition, the usual cardiovascular risk factors of age, sex, socioeconomic position, blood pressure, body mass index, smoking, cholesterol, and type 2 diabetes did not account for the elevated risk.

Another interesting finding is that autoimmune disease may play a significant role in the development of premature cardiovascular disease, which may lead to a disproportionate loss of life years and disability. This excess risk is particularly high in patients with autoimmune disorders under the age of 55.

Data for the study came from the UK’s Clinical Practice Research Datalink (CPRD), a massive database containing anonymised patient information for around 20% of the current population.

The researchers created a cohort of patients who had recently been diagnosed with any of the 19 autoimmune illnesses from 22 million medical records.

They then compared the incidence of 12 cardiovascular events to a matched control group, using an unparalleled level of granularity made feasible by the extremely vast size of the information.

Patients with several autoimmune disorders had a 1.56-fold increased risk of cardiovascular disease than those without autoimmune disease.

They also discovered that the excess risk increased with the variety of autoimmune diseases that a patient had. The conditions with the biggest extra risk included type I diabetes, Addison’s illness, lupus, and systemic sclerosis.

Need for focused preventative action

Nathalie Conrad, the study’s lead author, said the findings demonstrate the necessity of taking action. 

“We see that the excess risk is comparable to that of type 2 diabetes,” says the author, adding, “But although we have specific measures targeted at diabetes patients to lower their risk of developing cardiovascular disease (in terms of prevention and follow-up), we don’t have any similar measures for patients with autoimmune disorders.”

Conrad believes that the study will increase awareness among autoimmune illness patients and physicians who treat them, including those in a wide range of specialities like cardiologists, rheumatologists, and general practitioners. 

“We need to develop targeted prevention measures for these patients. And we need to do further research that helps us understand why patients with an autoimmune disorder develop more cardiovascular diseases than others, and how we can prevent this from happening.”

When it comes to the pathophysiology, the fundamental mechanisms remain mostly mysterious.

“The overall theory is that persistent and systemic inflammation, which is a prevalent factor in autoimmune illnesses, can cause all types of cardiovascular disease,” according to Conrad.

Patients’ cardiovascular risk is also probably influenced by the effects of autoimmune disease on connective tissues, tiny blood arteries, and cardiomyocytes, as well as perhaps some of the popular treatments for autoimmunity. 

“This really needs to be investigated thoroughly.”

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