Log in to MyACC
Autoimmune Diseases and Coronary Atherosclerosis
Quick Takes
- The current analysis from a national registry (in Denmark) of patients undergoing coronary CTA evaluated the relationship between autoimmune diseases (18 different diseases) and risk of coronary atherosclerosis and ASCVD events over 5 years of follow-up.
- The analysis included over 85,000 patients (52% women) and showed that presence of autoimmune diseases significantly increased risk of coronary plaque, CAC >0 and above 90th percentile. The risk of future ASCVD events was increased in the presence of a history of autoimmune disease (aHR, 1.46; 95% CI, 1.29-1.65).
- Patients with autoimmune diseases and traditional ASCVD risk factors were at the highest risk of ASCVD events and findings highlight the importance of optimizing modifiable risk factors in this patient group.
Study Questions:
Do autoimmune diseases independently correlate with coronary atherosclerosis and atherosclerotic cardiovascular disease (ASCVD) risk, and do traditional cardiovascular risk factors modulate the risk?
Methods:
The study included 85,512 patients from the Western Denmark Heart Registry undergoing coronary computed tomography angiography (CTA). A diagnosis of 1 of 18 autoimmune diseases was assessed. Adjusted odds ratios (aORs) for any plaque, any coronary artery calcification (CAC), CAC >90th percentile, and obstructive coronary artery disease (CAD) and adjusted hazard ratios (aHRs) for ASCVD were calculated.
Results:
During 5.3 (interquartile range, 2.8-8.2) years of follow-up, 3,832 ASCVD events occurred. A total of 4,064 patients had a diagnosis of autoimmune disease, which was associated with both presence of any plaque (aOR 1.29; 95% confidence interval [CI],1.20-1.40), any CAC (aOR, 1.28; 95% CI, 1.19-1.37), and severe CAC >90th percentile (aOR, 1.53; 95% CI, 1.39-1.68), but not with having obstructive CAD (aOR, 1.04; 95% CI, 0.91-1.17). Patients with autoimmune diseases had a 46% higher risk (aHR, 1.46; 95% CI, 1.29-1.65) for ASCVD. Traditional cardiovascular risk factors were strongly associated with future ASCVD events, and a favorable cardiovascular risk factor profile in autoimmune patients was associated with approximately 54% lower risk compared to patients with the presence of risk factors (aHR, 0.46; 95% CI, 0.27-0.81).
Conclusions:
Autoimmune diseases were independently associated with a higher burden of coronary atherosclerosis and higher risk for future ASCVD events, with risk accentuated by traditional cardiovascular risk factors. These findings suggest that autoimmune diseases increase risk through accelerated atherogenesis, and that cardiovascular risk factor control is key for improving prognosis in patients with autoimmune diseases.
Perspective:
Autoimmune diseases have been linked to an increased risk of ASCVD events, although the exact mechanism of this relationship is incompletely understood. Inflammation and autoantibodies may represent a common pathway linking the two disease processes. The current analysis from a national registry (in Denmark) of patients undergoing coronary CTA evaluated the relationship between autoimmune diseases (18 different diseases) and risk of coronary atherosclerosis and ASCVD events over 5 years of follow-up. The analysis included over 85,000 patients (52% women) and showed that the presence of autoimmune diseases significantly increased the risk of coronary plaque, CAC >0 and above the 90th percentile. The risk of future ASCVD events was increased in the presence of a history of autoimmune disease (aHR, 1.46; 95% CI, 1.29-1.65).
Barring the limitations of registry data and unmeasured bias, the findings suggest that the presence of autoimmune diseases increases the risk of ASCVD events. Patients with autoimmune diseases and traditional ASCVD risk factors are at the highest risk of ASCVD events and the findings highlight the importance of optimizing modifiable risk factors in this patient group. Whether therapies for autoimmune disease mitigate ASCVD risk remains to be determined.
Clinical Topics: Prevention
Keywords: Atherosclerosis, Autoimmune Diseases, Heart Disease Risk Factors
< Back to Listings
