Introduction

Autoimmune conditions are common diseases which can bring a host of chronic conditions and symptoms that can severely affect your quality of life. Amongst these many complications, cardiovascular effects from autoimmune conditions are often overlooked, yet they can be the most life-burdening. 

Many autoimmune conditions are linked to initiating cardiovascular health complications due to the inflammatory reactions that they trigger.¹ 19 autoimmune conditions have been noticed to affect cardiovascular health, with certain conditions more likely to lead to these complications than others. This includes Systemic Lupus Erythematosus (SLE), Type 1 diabetes and Systemic Sclerosis. 

Discover the various autoimmune conditions that can lead to potential cardiovascular health problems. This article delves into the relationship between autoimmune conditions and poor cardiovascular health.

Background

Autoimmune conditions have the power to attack your own cells, tissues, and organs due to immune dysfunction, leading to chronic inflammation and tissue damage.² The body mistakenly attacks itself, due to the immune system failing to differentiate itself from foreign pathogens.³ This alone can result in life-threatening complications and possibly lead to disability and death, especially when targeting vulnerable organs like the heart.^2,4 Factors such as genetics, environmental triggers, gender disparity and abnormal immune responses are known to be prevalent in developing autoimmune diseases.⁴ For example, every four out of five people diagnosed with an autoimmune condition are female.⁵

The heart is a frequent target for autoimmune diseases to attack, commonly causing various physical abnormalities to the heart and impairing its natural functions.² However, cardiac damage can be hard to detect from autoimmune conditions, especially in its early stages.² The mechanisms for which autoimmune disorders can cause damage to the heart are still unclear, but chronic inflammation is theorised to play a huge role.²

Common autoimmune conditions that elicit the most cardiovascular health problems

A study revealed that per 1000 patients with autoimmune conditions, 23.3 cases of cardiovascular health issues were shown.¹

Research has shown that common autoimmune conditions that lead to cardiovascular problems include the following: 

• Type 1 diabetes
• Systemic sclerosis 
• Addison's disease
• Systemic lupus erythematosus (SLE)¹

Rheumatoid arthritis (RA)

Rheumatoid arthritis (RA) is an inflammatory condition primarily affecting the joints, also known as arthritis.⁶ Not only does it affect the muscles and joints, but it can increase the risk of cardiovascular health problems such as heart failure, acute myocarditis and valvular diseases (diseases where one or more of the heart’s valves do not function properly).² Fibrinous pericarditis, a condition where the pericardium of the heart is inflamed, can be caused by RA; 50% of RA cases have a link to issues in the pericardium.⁶ Studies have previously reported almost a doubled increase in risk for heart-related conditions or even cardiovascular mortality compared to the general population.⁷ On the contrary, many of those who developed RA, did not have later cardiovascular complications, where any changes seen were asymptomatic with no noticeable differences (subclinical changes).² 

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus (SLE), or lupus, is very damaging to cardiovascular health as it causes inflammation throughout your body and can act on any component of the heart.² This autoimmune disease primarily affects young women, making early cardiovascular health problems deeply affect their quality of life.⁸ 

Systemic sclerosis 

Cardiovascular involvement in systemic sclerosis (an autoimmune disease which targets your nerves) has a strong link but is often difficult to determine, as it can show up as fibrosis, myocardial damage, pericardial or valvular disease.⁹ Not only does it have a direct consequence on heart health, but secondary effects could manifest through the kidneys, pulmonary arterial hypertension (PAH) and lung diseases.⁹ Frequent screening and tests for diagnosis are vital for immediate treatment and prevention plans.⁹

Type 1 diabetes 

Type 1 diabetes mellitus (T1D) has a well-established relationship with premature cardiovascular health problems though the reasons are less understood.¹⁰ This is one of the few autoimmune conditions where men and women have similar threats for heart health issues.¹⁰ Hyperglycaemia or high blood sugar increases the risk of cardiovascular disease for T1D.¹⁰

Psoriasis

Long-lasting inflammation in the body from moderate or intense psoriasis can affect both your heart and blood vessels, increasing the risk of cardiovascular problems such as heart diseases, strokes and heart-related deaths compared to individuals without psoriasis.¹¹ Further studies are required on whether there is a strong relation between psoriasis and heart health, as some studies have conflicting responses.¹¹

Which autoimmune diseases cause the most cardiovascular problems?

Systemic sclerosis and systemic lupus erythematosus (SLE) were found to have the highest associated cardiovascular condition risk.¹² However, 19 common autoimmune disorders were shown to have an increased risk of premature cardiovascular complications by 1.5-3.5x. Therefore, caution must be taken regardless of the type of autoimmune disorder.^12,13

Treatment for autoimmune disorders could be a possible reason for cardiovascular system consequences. Further studies are required to see the side effects of autoimmune drug therapy and its relation to cardiovascular health.¹² Corticosteroid therapy is questioned to play a part in worsening coronary artery atherosclerosis, a common trait seen in patients with rheumatoid arthritis.⁶

Potential risk factors for cardiovascular disease

• Age: studies have shown that there is an excess risk for cardiovascular health problems for younger individuals, resulting in many years of lost life and even disability^13,14 
• Genetics: family history can contribute to the high cardiovascular risk noticed in patients¹²
• Medications: some autoimmune treatments such as corticosteroid therapy can worsen cardiovascular health problems, potentially through side effects including weight gain¹²
• High cholesterol levels¹¹

Reducing traditional risk factors for those with autoimmune conditions is vital, including weight management, smoking cessation, hypertension and high blood sugar (hyperglycaemia).⁸

Limitations

Whilst many studies link autoimmune diseases to the development of cardiovascular health problems, further research is required on the mechanisms behind why this is the case and whether autoimmune treatment plans play a role in future cardiovascular problems detected in patients. Interestingly, some research has mentioned that poor cardiovascular health can be the risk factor to ignite or worsen autoimmune conditions, making this a complex relationship.⁴

Summary

It is vital to remember that while autoimmune conditions increase the risk of cardiovascular disease, this is not always the case. However, cardiovascular risk prevention should be acknowledged during the management of autoimmune diseases. A connection is acknowledged between poor heart health and the presence of autoimmune diseases.