The disparity in deaths between women and men was greatest in people with rheumatoid arthritis (RA) — women with RA were 3 times more likely to die of heart disease compared with men.
“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, director of cardio-rheumatology at Cleveland Clinic in Ohio.
Immune-mediated inflammatory diseases are a subset of autoimmune conditions and include rheumatoid arthritis as well as Crohn’s disease, ulcerative colitis, psoriasis, asthma, multiple sclerosis, and lupus.
Inflammation Caused by Autoimmune Conditions Can Damage the Heart
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, says Dr. Wassif.
Cardiovascular Deaths Dropped Over 20 Years, but Gender Gap Remains
For this trial, investigators focused on cardiovascular deaths between 1999 and 2020 in people with one of three conditions: rheumatoid arthritis, lupus, and systemic sclerosis, also called scleroderma.
Out of over 281,000 deaths tied to these diseases over this time period, more than 127,000 were linked 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 Wassif.
Deaths decreased from 3.9 to 2.1 per 100,000 women and from 1.7 to 1.2 per 100,000 men.
In other words, although heart disease deaths went down for everyone, the gender gap remained.
While it’s certainly good news that the overall number of cardiovascular deaths in these groups of people have gone down, the study really reveals a troubling gap between women and men, says Michael Garshick, MD, a cardiologist and cardio-rheumatologist at NYU Langone Health in New York City, who was not involved in the research.
“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,” says Dr. Garshick.
Why Are Women With Autoimmune Diseases at Higher Risk?
Garish thinks a big part of the gap could be that heart disease and its risk factors are 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.
More research is needed to investigate the “why,” says Wassif. The higher number of deaths in women could also be related to other diseases they have, access to treatment, or differences in how symptoms present themselves, the authors wrote.
Managing Autoimmune Conditions and Heart Disease Risk Can Improve Outcomes
It’s likely that the downward trend for cardiovascular death is due to both autoimmune disease treatment and cardiovascular treatments, says Wassif.
Biologic therapies that are used to manage many autoimmune conditions can help reduce systemic inflammation, which means less damage to the heart.
Medications like statins and high blood pressure drugs have also been shown to reduce the risk of early death due to events like heart attack and stroke, the authors wrote.
Don’t Put Off Taking Care of Your Heart Health
A big lesson here is that everyone with an autoimmune condition — especially women — should advocate for themselves to make sure that they are getting the help they need to manage cholesterol levels, blood pressure, and other risk factors, says Garshick.
People with autoimmune conditions often have a lot of different doctors and health issues to manage, he points out: “Because of that, addressing cardiovascular risk may keep getting pushed to ‘the next appointment,’ over and over again, sometimes until it’s too late.”
There can also be some hesitancy because people are afraid about the side effects of certain medications, says Garshick. “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.