Learn about the connection between heart disease and autoimmune disease.

When your body activates your immune system, it sends out inflammatory cells to attack germs and heal damaged tissue. If you have chronic inflammation, your body sends out inflammatory cells even though you’re not sick or injured. Inflammation is a symptom of many diseases.

Inflammatory diseases (IDs) or diseases of the autoimmune system include:

  • Addison’s disease.
  • Ankylosis spondylosis.
  • Irritable bowel disease (IBD).
  • Myasthenia gravis.
  • Multiple sclerosis.
  • Psoriasis.
  • Psoriatic arthritis.
  • Rheumatoid arthritis.
  • Systemic lupus erythematosus.
  • Systemic sclerosis.
  • Type 1 diabetes.
  • Vitiligo.
  • And many more.

These inflammatory conditions bring their own symptoms that must be managed. But they also may carry a higher risk of cardiovascular (heart) disease.

“Doctors noticed over many years that their patients with inflammatory disease often had cardiovascular events up to a decade before their peers without inflammatory disease,” says Anum Saeed, MD, cardiologist and lipidologist at UPMC Heart and Vascular Institute.

“Developing an inflammatory disease in your 30s and 40s — due to high cholesterol, diabetes, obesity, or some other compounding factors from lifestyle or genetics — is often a rude awakening and a window to that inflammatory condition manifesting itself as heart disease later in life. And, with that, (you have) the higher likelihood of a cardiovascular event such as a heart attack or stroke.”

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Risk of Heart Disease with Autoimmune Disease

Dr. Saeed says few randomized/controlled trials have been done to prove the connection between autoimmune disease and heart disease. But, in a 2022 observational study of a large population published in The Lancet, researchers found:

  • 15.3% of people diagnosed with an autoimmune disease in their mid-40s developed cardiovascular disease during a follow-up period that ranged from 2.7 to 10.8 years. In comparison, 11% of people without ID developed cardiovascular disease.
  • The incidence rate of developing cardiovascular disease was higher in patients with ID than patients without ID.
  • There was an increased risk of cardiovascular disease with ID for every type of cardiovascular disease studied. That risk increased progressively with the number of IDs a patient had.

Among types of IDs, systemic sclerosis, Addison’s disease, lupus, and Type 1 diabetes had the highest overall cardiovascular risk.

The ratio of patients in the study who had ID was roughly 60% women to 40% men. This higher incidence of women developing an autoimmune disease also has been shown in data from the National Institutes of Health, which cites a fourfold increase in risk for autoimmune disease in women compared to men.

Scientists have hypothesized many potential reasons for that disparity, such as sex hormones, the X chromosome, microchimerism, the environment, and the microbiome. But the true cause is not known.

Preventing Heart Disease with Autoimmune Disease

Dr. Saeed says people with autoimmune or inflammatory diseases can take several steps to try to prevent cardiovascular disease.

1. Get a cardiovascular risk assessment.

Dr. Saeed likens the body’s arteries to a series of pipes. Over time, many different factors can cause plaque to form and damage the inside walls of the pipes. These causes may include:

  • Aging.
  • Cigarette smoking.
  • Diabetes.
  • High blood pressure.
  • Other factors.

Plaque can build up and block blood flow or break off and travel to the heart, causing a heart attack, or to the brain, causing a stroke. It also can develop as a clot elsewhere in the body.

“Your physician can run a test called a coronary calcium score,” Dr. Saeed says. “A high coronary calcium score is sort of a snapshot across your lifetime because it detects the buildup of all the coronary calcium or plaque in your arteries. But with dietary changes and a statin drug, you can reduce your inflammatory burden and your cholesterol. As preventive care, the benefits of taking a statin drug outweigh the risks.”

2. Talk to your doctor about getting inflammatory disease screening.

A simple blood test called the C-reactive protein (CRP) test can detect inflammation levels.

“A high CRP signals a high inflammatory burden,” Dr. Saeed says. “Patients can cut their risk by almost half through medication and lifestyle changes as recommended by their physician, such as cutting out smoking and red meat.”

3. Check out your risk of cardiovascular disease on the ASCVD Risk Estimator tool.

This online tool comes from the American College of Cardiology and the American Heart Association. You can plug in your personal numbers — such as age, blood pressure, total cholesterol, HDL, and more — and other health information. The tool calculates your risk of developing cardiovascular disease within the next 10 years. If you’re under age 59, you also can calculate your lifetime risk of developing cardiovascular disease.

“These numbers also can tell you if you should get a cardiovascular risk assessment,” Dr. Saeed says. “If someone scores over 7%, they should be on a statin drug. If they score in the 5% to 7% range and they have an autoimmune disorder or are at high risk for an inflammatory disorder due to their family history, they also should be on a statin drug. So, consider talking to your doctor about this score.”

What Should I Do If I Have an Inflammatory Disease?

If you have any type of autoimmune or inflammatory disease, talk to your primary care provider about getting on a lipid-lowering statin drug. It can lower your risk of developing heart disease.

For more information, visit the UPMC Heart and Vascular Institute website.

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.