Adults With Congenital Heart Disease Have an Increased Prevalence of Autoimmunity

Adult congenital heart disease (ACHD) individuals have increased risk of noncardiac comorbidities including cancer and infections. Whether they are at increased risk of autoimmunity is unknown.

The purpose of this study was to understand the association of ACHD and risk for autoimmunity.

A case-control study was performed using All of Us, a nationwide biomedical database. In 2024, we queried autoimmune conditions and ACHD individuals ≥18 year of age with congenital heart disease (CHD) diagnoses determined using SNOMED, International Classification of Diseases (ICD)-9-CM, and ICD-100-CM classifications. ACHD individuals were matched 1:20 to controls for age, race, sex, smoking, and obesity. We examined subcategories of mild/moderate/severe CHD.

Among 287,012 participants, 2941 ACHD (1.02%) individuals (mean age 62 years, 55.3% female) were identified. ACHD individuals had increased odds of autoimmunity (OR: 1.95; P < 0.05), both systemic (OR: 1.94; P < 0.05) and organ specific (OR: 1.54; P < 0.05) conditions. Sixty-nine percent had sufficient detail to be classified into mild/moderate/severe CHD; severe group was smaller and younger (n = 162, mean age = 47.6 years) compared to mild (n = 1169, mean age = 63.8) and moderate (n = 703, mean age = 61.8 years) groups. Mild and moderate CHD were associated with autoimmunity (OR: 1.93; P < 0.05 and OR: 1.56; P < 0.05, respectively). The entire severe CHD group did not show an increase in odds of autoimmunity (OR: 1.45; P = 0.168). When the groups were subdivided by age, severe ACHD individuals ≥60 years did show increased odds of autoimmunity (OR: 2.71; P < 0.05).

ACHD individuals showed a nearly 2-fold increased odds of developing autoimmune conditions, both for systemic and organ-specific autoimmunity, which persisted among those with simple/moderate CHD. In an age-related analysis, the severe CHD group ≥60 years has a similar risk.