Heart Health
Autoimmune diseases pose a threat to the heart
The growing field of cardio-rheumatology aims to improve cardiac care for people with autoimmune diseases.
- Reviewed by Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
Your immune system, a network of specialized cells and organs, defends your body against viruses, bacteria, and other invaders. But sometimes, for reasons that remain largely mysterious, immune cells launch an inappropriate attack against the body's own tissues. The resulting outpouring of white blood cells and other substances cause inflammation, triggering the pain, redness, and swelling that characterizes many autoimmune diseases (see "Autoimmune diseases: From common to rare").
But inflammation also damages the linings of blood vessels, encouraging the buildup of fatty plaque that can narrow arteries (atherosclerosis), boost blood pressure, and raise the risk for a heart attack or stroke. This connection likely explains why people with autoimmune conditions, such as rheumatoid arthritis, have higher rates of heart disease. Until recently, however, the scope and severity of this problem has been unclear.
Autoimmune diseases: From common to rareIn the United States, up to 8% of people have an autoimmune disease, which occurs when the immune system mistakenly attacks healthy organs or tissues. For unknown reasons, women are twice as likely as men to develop these conditions. Out of the more than 100 known autoimmune diseases, the three described below are among the most common and best studied. But the majority are rare and therefore less well understood. Psoriasis. The inflammation in psoriasis affects the skin, causing a pink or dull-red, scaly skin rash that occurs in patches, usually on the back of the elbow, in skin folds, and on the scalp. About one in three people with psoriasis also has psoriatic arthritis, which causes joint inflammation (especially in the fingers, toes, or knees) and morning stiffness. Rheumatoid arthritis. The immune system attack targets tissue lining the joints, creating inflammation marked by swelling, pain, and stiffness. It typically strikes multiple joints at once, especially in the hands and feet. Other symptoms include fatigue and lingering morning stiffness. Lupus. The inflammatory process in lupus can affect almost any organ in the body, triggering a wide array of symptoms. Common early symptoms include fever and joint pain similar to rheumatoid arthritis. One distinct symptom is a a "butterfly rash" across the bridge of the nose and cheeks. Damage to the heart, lungs, kidneys, and blood vessels can also occur. |
A heightened risk
But in 2022, the Lancet published a study that looked at cardiovascular disease rates in combination with 19 of the most common autoimmune diseases. Depending on the specific condition, people with these diseases were up to three times more likely to develop cardiovascular disease than people without an autoimmune disease.
"My patients have said to me, 'I had no idea that my autoimmune disease could affect my heart,'" says Dr. Brittany Weber, a cardio-rheumatology specialist at Harvard-affiliated Brigham and Women's Hospital. Many of the people she treats have rheumatoid arthritis, psoriatic arthritis, or lupus — three common conditions linked to cardiovascular problems.
Awareness of this elevated risk is especially important because autoimmune disease typically strikes when people are in their 20s or 30s. In turn, heart problems may develop up to a decade earlier than in people without an autoimmune disease. A calcium scan, which detects early signs of atherosclerosis, can help assess a person's risk and guide treatment advice, says Dr. Weber. Sometimes, people blame rheumatoid arthritis for symptoms (for example, shortness of breath when climbing stairs) that are actually caused by heart disease, she adds.
Treatment advice
In addition to prescribing statins and other medications that lower heart attack risk, cardio-rheumatologists also work with rheumatologists to manage the appropriate use of disease-modifying biologic drugs, some of which carry a higher risk of cardiovascular side effects than others.
The same diets recommended for preventing heart disease are also beneficial for people with autoimmune diseases. Maintaining a healthy weight helps, too. Exercise is often particularly challenging for people with autoimmune diseases, especially those with severe cases of rheumatoid arthritis, who may have limited mobility. "Many of my patients like swimming, which is easy on the joints," says Dr. Weber. Others find yoga to be helpful, especially because of the added stress relief and relaxation yoga provides. Using an elliptical machine is another exercise that can raise the heart rate without putting too much pressure on the joints.
Image: © Adam Gault/Spl/Getty Images
About the Author
Julie Corliss, Executive Editor, Harvard Heart Letter
About the Reviewer
Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
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