Research Highlights:
DALLAS, May 6, 2025 — Women with the autoimmune diseases rheumatoid arthritis, lupus or systemic sclerosis may have a higher rate of death related to cardiovascular disease than men with the autoimmune diseases, according to new research published in the American Heart Association’s journal Circulation: Cardiovascular Quality and Outcomes .
According to the National Institute of Allergy and Infectious Diseases , an estimated 8% of the U.S. population — approximately 27 million people — have an autoimmune disease. Immune-mediated inflammatory diseases, such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, asthma, multiple sclerosis and systemic lupus erythematosus, also called lupus, are a broad subset of autoimmune diseases that involve chronic inflammation, which can contribute to cardiovascular disease . Additionally, previous research has found that after a heart attack, people with the immune-mediated inflammatory diseases lupus, rheumatoid arthritis, systemic sclerosis, dermatomyositis or psoriasis were more likely to die, develop heart failure or have a second heart attack in comparison to people without one of these autoimmune diseases.
Rheumatoid arthritis, lupus and systemic sclerosis are among the most common immune-mediated inflammatory diseases, the authors said. Women are two to three times more likely than men to have rheumatoid arthritis and approximately nine times more likely than men to have lupus , according to the U.S. Centers for Disease Control and Prevention. Systemic sclerosis, also called scleroderma , is a group of rare autoimmune diseases distinct from multiple sclerosis that involves the tightening and hardening of the skin, potentially affecting the digestive tract, blood vessels and internal organs. It is also more common among women than men, according to the CDC. However, understanding the differences between men and women in the rate of cardiovascular disease-related death linked to immune-mediated inflammatory diseases such as these remains relatively unexplored, the study authors noted.
“Our study highlights the significant burden of cardiovascular disease in patients with immune-mediated inflammatory diseases, which disproportionately affect women,” said senior study author Heba S. Wassif, M.D., M.P.H., an assistant professor at Lerner College of Medicine of Case Western Reserve University and director of cardio-rheumatology at Cleveland Clinic, both in Cleveland. “It is critical to screen for and address cardiovascular risk factors early, at the time of diagnosis and periodically thereafter.”
Researchers analyzed data from the CDC WONDER database for more than 127,000 deaths related to cardiovascular disease among more than 281,000 deaths associated with rheumatoid arthritis, lupus or systemic sclerosis. The researchers evaluated trends and differences in the rates of cardiovascular disease-related death for men and women with the most common auto-immune conditions between 1999 and 2020.
The analysis found:
“There is a common perception that people with immune-mediated inflammatory diseases primarily die from infections or kidney disease. 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,” said lead study author Issam Motairek, M.D., an internal medicine resident at Cleveland Clinic."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."
Study details and background:
The study’s limitations include that the findings may underestimate or overestimate death rates due to potential cause-of-death coding misclassifications in the CDC records in this analysis. Additionally, the contribution of immune-mediated inflammatory diseases to cardiovascular disease may be underestimated because less-common autoimmune diseases were not included in the study. The study also did not include information for individual patients about other health conditions and treatment because this data is not available in the CDC WONDER database and could not be considered in the analysis.
“As we gain a deeper understanding of inflammation’s role in cardiovascular disease, we must translate this knowledge into targeted prevention strategies to reduce cardiovascular disease-related deaths in women with immune-mediated inflammatory diseases,” Wassif said. “Key questions remain about the underlying causes of these disparities between women and men, about which therapies could be most effective in reducing risk, and about our understanding of the nature of coronary artery disease in patients with immune-mediated inflammatory diseases. Future research is needed to help address these gaps and improve outcomes for this high-risk population.”
Co-authors, disclosures and funding sources are listed in the manuscript.
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Circulation Cardiovascular Quality and Outcomes
10.1161/CIRCOUTCOMES.124.011833
Sex Differences in Cardiovascular Mortality Among Patients With Immune Mediated Inflammatory Diseases