Autoimmune conditions and heart disease

When the body’s immune system goes awry and mistakenly attacks its own tissues, it triggers an outpouring of white blood cells and other substances. Known as inflammation, this largely invisible, insidious process is the hallmark of autoimmune systemic inflammatory diseases (see “Mysterious immune system misfires”).

Inflammation is also at the heart of cardiovascular disease. When fatty plaque builds up inside arteries, the body perceives it as foreign and enlists a similar arsenal of white blood cells. These further ignite an inflammatory response, creating conditions that encourage the blood clots that are responsible for most heart attacks and strokes.

So it’s perhaps not surprising that people with autoimmune inflammatory diseases are more likely to have heart attacks and to die of cardiovascular disease than people in the general population. Growing recognition of this problem — and the related treatment challenges for affected patients — has spurred a new specialty known as cardiorheumatology, says Dr. Katherine Liao, codirector of the Cardiovascular Rheumatology Clinic at Harvard-affiliated Brigham and Women’s Hospital.

“For many years, there weren’t good therapies for rheumatoid arthritis and related inflammatory diseases,” she says. But that changed about two decades ago, with the development of targeted drugs known as biologics that modify the body’s response to inflammation. With these improved therapies, people started living longer. Soon, cardiovascular disease emerged as a leading cause of death for people with these conditions.

Mysterious immune system misfiresYour immune system normally protects your body against viruses, bacteria, and other invaders. But sometimes immune cells launch an inappropriate attack against the body’s own tissues. The resulting conditions, known as autoimmune systemic inflammatory diseases, include these: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 a type of inflammatory arthritis known as psoriatic arthritis, which causes joint inflammation (especially in the fingers, toes, or knees) and morning stiffness in addition to the characteristic rash.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 morning stiffness that lasts more than an hour and fatigue.Systemic lupus erythematosus. 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 rash across the bridge of the nose and cheeks, called a “butterfly rash.” The immune system attack can also damage the heart, lungs, kidneys, and blood vessels.

More deadly heart attacks

Heart attacks are twice as likely to be fatal in younger adults with systemic inflammatory conditions, according to a study co-authored by Dr. Liao in the March 30, 2021, European Journal of Preventive Cardiology. People with inflammatory conditions were more likely to have higher blood pressure, but they had similar rates of high cholesterol and diabetes compared with people without inflammatory disease.

Just like diabetes, systemic inflammatory conditions such as psoriasis, lupus, and rheumatoid arthritis should be considered “risk enhancers” when it comes to estimating a person’s odds of heart problems, according to the 2019 expert guidelines for heart disease prevention. Still, the heart risks from these less-common conditions may be underappreciated. In the recent study, people with inflammatory diseases were less likely to be prescribed aspirin and statins, although both can help lower the risk of a repeat heart attack.

Treatment options

Currently, there aren’t clear guidelines about how to best prevent and manage cardiovascular disease in people with systemic inflammatory diseases beyond what is recommended for the general population. Some medications used to treat rheumatoid arthritis and related conditions may lower the risk for dying from heart disease, including methotrexate (Rheumatrex, Trexall) and biologic drugs known as TNF-alfa inhibitors. These include infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel).

Nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and celecoxib (Celexa) may be prescribed to control pain and swelling. But these drugs can raise blood pressure and are linked to a higher risk of a heart attack. At Dr. Liao’s clinic, cardiologists and rheumatologists work closely together to provide the best possible care for people with both conditions.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

2 Chronicles 7:16 “For now I have chosen and consecrated this house that My name may be there forever, and My eyes and My heart will be there perpetually.

2 Corinthians 9:10 Now He who supplies seed to the sower and bread for food will supply and multiply your seed for sowing and increase the harvest of your righteousness;

Hebrews 5:12-14 For though by this time you ought to be teachers, you have need again for someone to teach you the elementary principles of the oracles of God, and you have come to need milk and not solid food. For everyone who partakes only of milk is not accustomed to the word of righteousness, for he is an infant. But solid food is for the mature, who because of practice have their senses trained to discern good and evil.

1 Peter 2:2 like newborn babies, long for the pure milk of the word, so that by it you may grow in respect to salvation,

Luke 8:14-15 “The seed which fell among the thorns, these are the ones who have heard, and as they go on their way they are choked with worries and riches and pleasures of this life, and bring no fruit to maturity. “But the seed in the good soil, these are the ones who have heard the word in an honest and good heart, and hold it fast, and bear fruit with perseverance.

Matthew 13:22-23 “And the one on whom seed was sown among the thorns, this is the man who hears the word, and the worry of the world and the deceitfulness of wealth choke the word, and it becomes unfruitful. “And the one on whom seed was sown on the good soil, this is the man who hears the word and understands it; who indeed bears fruit and brings forth, some a hundredfold, some sixty, and some thirty.”

Mark 4:19-20 but the worries of the world, and the deceitfulness of riches, and the desires for other things enter in and choke the word, and it becomes unfruitful. “And those are the ones on whom seed was sown on the good soil; and they hear the word and accept it and bear fruit, thirty, sixty, and a hundredfold.”

2 Corinthians 9:10 Now He who supplies seed to the sower and bread for food will supply and multiply your seed for sowing and increase the harvest of your righteousness;

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