Immune System Diseases and Cardiovascular Risk

Although coronary artery disease and other vascular diseases are some of the leading causes of death and disability in the United States, most patients do not realize that connective tissue diseases can also lead to heart damage. For instance, lupus, rheumatoid arthritis, scleroderma, polymyositis, dermatomyositis, and mixed connective tissue disease are all conditions that can lead to secondary heart disease. Surprising to most patients is that these diseases negatively affect the valves of the heart, the coronary arteries, and even the general conduction system of the heart. Patients with a connective tissue disorder should make sure to speak with their own primary care physician or a qualified cardiologist about their risk profile. Increased awareness about secondary heart disease can potentially lead to reduced mortality rates.

Lupus (known also as systemic lupus erythematosus) is characterized by fatigue, muscle pain, arthritis, photosensitivity, and serositis (a type of inflammation). The is a genetic component to the disease, evidenced by the fact that members of the same family are more likely to suffer from it as compared with the general population. Females are also affected far more often than males for reasons that are still unknown. Even though there are many other complications of lupus, cardiovascular disease is third on the list of those that cause the most harm. Cardiac damage occurs due to the general inflammation that lupus creates - so in addition to the skin irritation, arthritis, etc., lupus often causes the valves of the heart and the heart lining to become inflamed and irritated. This irritation then leads to valvular heart disease or valve stenosis (narrowing).

Rheumatoid arthritis, like lupus, is an immune-mediated inflammatory disease. Patients with this condition tend to awaken with morning stiffness in the joints (especially the hands), and to suffer from joint pain. Evidence of deteriorating joints is visible via x-ray in most patients. Although the disease occurs only in about 1% of the population, females are again more likely to have it than are males. It is believed that so-called rheumatoid cardiovascular disease is caused by a nonspecific type of inflammation regulated by the immune system. This inflammation causes deposits to build up inside different areas of the heart. These deposits or areas of buildup are called granulomas; a granuloma is a tiny collection of immune cells (known as macrophages). The more buildup or deposits created in a patient's heart, the more damage it can potentially cause. While not entirely treatable, in some cases, pericarditis that has resulted from rheumatoid arthritis can be treated with corticosteroids. If large areas of the heart are affected before treatment is initiated, however, mortality rates are higher. Cases that are treated early tend to have the best outcomes. Valvular disease that results from rheumatoid arthritis is more difficult to treat, as no specific therapy has been developed. Sometimes, however, immunosuppressive agents are useful at mitigating symptoms.

Polymyositis (or dermatomyositis) is an acquired and chronic inflammatory condition that can cause muscle weakness, skin lesions, and rashes. Sometimes, polymyositis occurs as part of another immune disorder like lupus and sometimes it occurs independently. Just like lupus and rheumatoid arthritis, it can lead to secondary cardiovascular disease. Normally, the heart problems caused by polymyositis surface as myocarditis (inflammation of the heart muscle), or via arrhythmias. Surprisingly, the heart disease in these patients does not differ between older and younger patients, or between men and women - all are equally affected and at risk for heart complications.

For patients that have already been diagnosed with an inflammatory or immune-regulated disease such as lupus, rheumatoid arthritis, or even polymyositis, becoming more aware of heart disease risk is a good first step. Unfortunately, clearly effective treatments and even the pathology of these types of secondary heart disease are not yet completely understood. The goal of cardiologists is to help patients remain healthier for longer and to reduce the numbers of individuals who ultimately die from secondary heart disease. All patients (regardless of whether they suffer from any type of illness) can benefit from a healthy diet, lower body weight, and from smoking cessation if necessary. In patients at risk for secondary heart disease, increased monitoring and checkups may also prove useful.

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