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Atherosclerotic Heart Disease in Women With Autoimmune Rheumatologic Inflammatory Conditions
Reto D Kurmann1, Rekha Mankad1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Women with inflammatory rheumatologic conditions face higher cardiovascular risks. Systemic inflammation, not just traditional factors, drives this increased risk, which current scoring systems often underestimate.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Women exhibit a higher prevalence of inflammatory rheumatologic conditions like systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc).
- These conditions are linked to increased cardiovascular (CV) morbidity and mortality, primarily due to atherosclerotic heart disease.
- Traditional CV risk factors do not fully explain the elevated risk in women with these autoimmune diseases.
Purpose of the Study:
- To highlight the underestimation of cardiovascular risk in patients with inflammatory rheumatologic conditions by current population-based scoring systems.
- To emphasize the significant role of systemic inflammation in driving CV risk in this patient group.
- To underscore the need for greater recognition of this elevated CV risk among internists and cardiologists.
Main Methods:
- Review of existing literature on cardiovascular risk in patients with inflammatory rheumatologic diseases.
- Analysis of the impact of systemic inflammation versus traditional risk factors on CV events.
- Comparison of current CV risk assessment tools with observed CV event rates in rheumatologic patients.
Main Results:
- Traditional risk factors inadequately predict CV risk in women with inflammatory autoimmune rheumatologic conditions.
- Patients with RA or SLE maintain a higher CV event risk even after controlling for traditional factors, attributed to systemic inflammation.
- Current general population CV risk scores underestimate the true CV burden in patients with rheumatologic diseases.
Conclusions:
- Systemic inflammation is a critical driver of cardiovascular risk in women with rheumatologic diseases.
- Existing cardiovascular risk assessment tools are insufficient for this complex patient population.
- Further research into inflammation and its management in cardiovascular disease is crucial and may benefit the general population.
Abstract:
Women have a higher prevalence of several inflammatory rheumatologic conditions. These include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc) to name a few. These conditions are all associated with higher rates of cardiovascular (CV) morbidity and mortality, which is driven primarily by atherosclerotic heart disease. Traditional risk factors are important considerations in the assessment of CV risk in the rheumatologic patient; however, these factors do not appear to impart a similar weight of risk in women with inflammatory autoimmune rheumatologic conditions. In addition, even when controlling for traditional risk factors, patients with RA or SLE continue to have a higher risk of CV events, which has been linked to the burden of systemic inflammation. Currently, the CV risk scoring systems available for the general population underestimate the burden of the problem in these complex patients. The increased CV risk in patients with rheumatologic diseases has been reported in the literature for years but remains underrecognized by internists and cardiologists. Although these conditions themselves are relatively rare, the further study of inflammation and its treatment in CV disease will be beneficial to the general population.
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