From the Guidelines
A patient with a history of autoimmune disorders should be referred to cardiology due to the significantly increased risk of cardiovascular complications associated with these conditions, as evidenced by a 50% increase in cardiovascular morbidity and mortality in patients with rheumatoid arthritis 1. The primary reason for this referral is the accelerated atherosclerosis and increased plaque burden, plaque vulnerability, and thrombogenesis seen in autoimmune diseases like rheumatoid arthritis, which can lead to premature cardiovascular disease (CVD) 1. Some key points to consider in the management of these patients include:
- The use of disease-modifying antirheumatoid drugs such as methotrexate, which have been associated with lower risk of cardiovascular events in observational studies 1
- The potential benefits of biologic disease–modifying antirheumatoid drugs in stabilizing and decreasing plaque as measured by coronary computed tomography angiography (CCTA) 1
- The importance of collaboration between cardiologists, rheumatologists, and immunologists to optimize medication regimens and minimize cardiovascular risk
- The need for specialized cardiovascular risk assessment and cardiac imaging, such as echocardiograms or stress tests, to identify and manage cardiac manifestations of the autoimmune disease
- The consideration of additional cardiovascular risk factors, such as hypertension or diabetes, which may further increase the risk of cardiovascular complications in these patients.
From the Research
Referral to Cardiology for Patients with Autoimmune Disorders
Referring a patient to cardiology if they have a history of autoimmune disorders is crucial due to the increased risk of cardiovascular disease (CVD) associated with these conditions. The following points highlight the importance of such referrals:
- Increased Risk of CVD: Patients with autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and gout have a higher risk of CVD compared to the general population 2, 3, 4.
- Mechanisms Underlying Increased Risk: The increased risk of CVD in patients with autoimmune diseases is attributed to a combination of traditional cardiovascular risk factors and disease-specific factors, including chronic low-grade systemic inflammation, endothelial activation, and a pro-thrombotic/pro-coagulant state 3, 4.
- Importance of Screening and Management: Screening for CVD is essential in patients with autoimmune diseases, and management should include tight control of disease activity, lifestyle interventions, and pharmacotherapy to minimize the use of nonsteroidal anti-inflammatory drugs and prolonged courses of high-dose corticosteroids 2.
- Association with Specific Autoimmune Diseases: Certain autoimmune diseases, such as systemic sclerosis, Addison's disease, systemic lupus erythematosus, and type 1 diabetes, have been found to have a higher overall cardiovascular risk 5.
- Progressive Risk with Multiple Autoimmune Diseases: The risk of CVD increases progressively with the number of autoimmune diseases present, highlighting the need for targeted cardiovascular prevention measures in patients with multiple autoimmune conditions 5.
- Age and Cardiovascular Risk: The risk of CVD is higher in younger patients with autoimmune diseases, emphasizing the importance of early referral to cardiology and implementation of preventive measures 5.