A large, long-term study has uncovered a striking and concerning health disparity, that women living with common autoimmune diseases face a significantly higher risk of dying from cardiovascular problems compared to men with the same conditions.
The research, which spanned over two decades, found that women with autoimmune diseases such as rheumatoid arthritis (RA), lupus, and systemic sclerosis were more than twice as likely as men to succumb to cardiovascular-related causes, including heart attacks, strokes, arrhythmias, and coronary artery disease.
The gap was most pronounced in women diagnosed with rheumatoid arthritis. In fact, the study found that women with RA were three times more likely to die of heart disease compared with men who shared the same condition. These findings shine a light on an important, yet often underrecognized, intersection between autoimmune conditions and heart health.
“Our study highlights the significant burden of cardiovascular disease in people with immune-mediated inflammatory diseases, which disproportionately affect women,” says senior study author Heba S. Wassif, MD, MPH, who serves as the director of cardio-rheumatology at the Cleveland Clinic in Ohio.
What Are Immune-Mediated Inflammatory Diseases?
Autoimmune diseases develop when the body’s immune system mistakenly attacks its own healthy tissues, leading to chronic inflammation and damage. A specific subgroup of these illnesses, known as immune-mediated inflammatory diseases, includes a range of conditions such as:
- Rheumatoid arthritis (RA)
- Crohn’s disease
- Ulcerative colitis
- Psoriasis
- Asthma
- Multiple sclerosis
- Lupus (systemic lupus erythematosus)
While each of these conditions affects different parts of the body, a common factor among them is the persistent inflammation they cause. Inflammation is the body’s natural response to injury or infection, but when it becomes chronic, it can damage tissues — including those of the cardiovascular system.
Estimates suggest that between 24 and 50 million people in the United States live with an autoimmune disease, and around 80% of those individuals are women. Despite this high prevalence, many people with autoimmune diseases remain unaware of the heightened cardiovascular risks they face.
As Dr. Wassif notes, “While it’s already been established that chronic inflammation from autoimmune conditions can damage the heart, many people living with these conditions aren’t aware of their increased risk.”
A previous study conducted in the United Kingdom involving over 22 million people found that simply having one of 19 different autoimmune conditions raised the risk of heart disease as much as traditional risk factors like type 2 diabetes and smoking.
Understanding Cardiovascular Disease
When people think of heart disease, they often focus solely on heart attacks, but cardiovascular disease is a much broader category encompassing a wide range of conditions affecting the heart and blood vessels. These include:
- Coronary artery disease (clogged arteries)
- Stroke
- Heart attack
- Heart failure
- Peripheral artery disease
- Heart valve disease
- Arrhythmia (irregular heartbeat)
- Pericarditis (inflammation of the heart lining)
- Deep vein thrombosis (DVT)
- Cerebrovascular disease
- Aortic heart disease
- Congenital heart defects
The impact of these conditions is profound, and when paired with chronic inflammation from autoimmune disease, the risk to heart health escalates dramatically.
Cardiovascular Deaths Declined, But Gender Inequity Persists
For this particular study, researchers analyzed cardiovascular deaths occurring between 1999 and 2020 in individuals diagnosed with one of three autoimmune conditions: rheumatoid arthritis, lupus, and systemic sclerosis (scleroderma).
Over those two decades, they tracked more than 281,000 deaths linked to these diseases, and of those, over 127,000 were attributed to cardiovascular causes.
“If you look at the data from a ‘glass half full’ perspective, the overall cardiovascular disease-related death rate in this group fell by more than half,” says Dr. Wassif. Between 1999 and 2020, cardiovascular deaths dropped from 3.9 to 2.1 per 100,000 women and from 1.7 to 1.2 per 100,000 men.
However, despite these encouraging overall reductions, the gender gap remained troublingly persistent. Cardiovascular deaths in women consistently outpaced those in men, even as overall mortality rates improved.
“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, MD, an internal medicine resident at the Cleveland Clinic, in a press release.
Why Do Women Face Greater Risk?
The reasons behind this gender-based health disparity are still being studied, but experts have several working theories. Michael Garshick, MD, a cardiologist and cardio-rheumatologist at NYU Langone Health in New York City, who was not involved in the research, believes one major issue is that heart disease and its risk factors are often underrecognized and undertreated in women.
“I think this is compounded by the fact that women are enrolled less frequently in clinical trials, and so there’s really a treatment gap in women in general,” he says.
Additionally, the study’s authors suggest other factors might contribute to the increased mortality rate among women. These could include disparities in access to medical care, variations in how heart disease symptoms present in women versus men, and the influence of other co-existing health conditions. More research is needed to investigate the ‘why,’ says Dr. Wassif.
Dr. Garshick also points out an interesting detail from the study, “Interestingly, when the authors also looked at sex differences in deaths due to cancer, infection, and respiratory illnesses, there was much less of a disparity, or in some cases, there was equal risk. That really highlighted the differences in outcomes between men and women when it comes to cardiovascular disease.”
The Importance of Managing Heart Health in Autoimmune Patients
The researchers emphasize that the decline in cardiovascular deaths over time is likely the result of better treatment for both autoimmune conditions and heart disease itself. In particular, the increased use of biologic therapies for autoimmune diseases has helped to reduce the levels of harmful systemic inflammation, thereby offering some protection to the heart.
At the same time, medications commonly prescribed for heart disease — including statins to lower cholesterol and antihypertensive drugs to manage blood pressure — have proven effective in reducing the risk of life-threatening cardiovascular events such as heart attacks and strokes.
“It’s likely that the downward trend for cardiovascular death is due to both autoimmune disease treatment and cardiovascular treatments,” says Dr. Wassif.
Don’t Delay Addressing Heart Health Risks
One of the most important takeaways from this study is the need for people with autoimmune diseases — and especially women — to proactively manage their heart health. Regular monitoring of cholesterol, blood pressure, blood sugar, and other cardiovascular risk factors can make a significant difference in long-term outcomes.
Dr. Garshick highlights a problem he often sees in clinical practice, explaining, “People with autoimmune conditions often have a lot of different doctors and health issues to manage. Because of that, addressing cardiovascular risk may keep getting pushed to ‘the next appointment,’ over and over again, sometimes until it’s too late.”
Fear of potential medication side effects can also deter some patients from starting treatments to manage heart disease risk. But Dr. Garshick reassures his patients, noting the significant progress in available treatments.
“I tell my patients that there’s no reason in 2025 that we can’t get you on an effective medication to lower your cholesterol, treat your diabetes, or manage your blood pressure that you can tolerate. We have so many great options to manage your risk factors,” he says.
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