Arthritis, and other diseases may increase post-heart attack risk

New research finds that after a heart attack, people with autoimmune diseases are more likely than others to die or experience more serious heart problems, including a second heart attack.

The study, published in the Journal of the American Heart Association, helps fill a gap in what is known about the long-term cardiovascular health of people with autoimmune diseases such as rheumatoid arthritis, psoriasis and lupus, researchers said.

“Evidence for the risk of adverse events after a heart attack for people with autoimmune disorders is less robust than evidence for people without these disorders, primarily from small or single-center studies,” study lead author Dr. Amjad Mintyas said in a news release. Release. He is an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine in Ohio.

According to estimates by the National Institutes of Health, up to 8% of people in the United States have an autoimmune disease, in which the immune system attacks the body’s organs, tissues, and cells.

The study used 2014-2019 data for people 65 and older from a government database of all US inpatient Medicare hospital bills. Autoimmune conditions.

The patients were followed for about two years after their heart attacks. The most common autoimmune conditions were rheumatoid arthritis, followed by systemic lupus, psoriasis, systemic sclerosis, and polymyositis/dermatomyositis.

The analysis showed that after a heart attack, people with autoimmune diseases were 15% more likely to die from any cause than those without autoimmune diseases. They were 12% more likely to be hospitalized with heart failure and 8% more likely to have another heart attack. They were also 6% more likely to undergo a second operation to open the arteries if they had one after a heart attack.

Dr. Heba Wassif, the study’s lead researcher, said that patients with autoimmune diseases and cardiovascular disorders should be managed by a cardiologist and rheumatologist who works with a rheumatologist. Wassef is an assistant professor of medicine at Cleveland Clinic Lerner Medicine and director of cardiology and rheumatology at Cleveland Clinic.

Autoimmune diseases are known to increase the risk of cardiovascular disease, possibly because people who suffer from it also tend to have traditional cardiovascular risk factors, including high blood pressure, type 2 diabetes, and kidney disease. Because of the autoimmune disease, people typically have chronic inflammation and autoimmune antibodies, and steroid medication is commonly used, all of which have been associated with a higher risk of cardiovascular disease.

“Traditional risk factors (cardiovascular disease) are becoming increasingly severe in this population, and how these risk factors are also unique,” Wassif said. “For example, cholesterol levels are affected by inflammation. So patients with active inflammatory disease have lower cholesterol levels, a phenomenon known as lipid paradox. Physical activity, which is highly recommended to improve cardiovascular outcomes, may be restricted by joint pain. .”

She said some treatments for autoimmune diseases may increase the risk. “Knowing these nuances and a team-based approach may improve outcomes.”

In the study, people with autoimmune diseases were less likely to have a procedure called cardiac catheterization to check for narrowed arteries. They were also less likely to have surgery or a procedure to open blocked arteries.

The researchers lacked information about the patients’ arterial anatomy and the severity of autoimmune diseases that might have helped them understand treatment decision making.

“It is possible that people with autoimmune diseases were not healthy enough to undergo these procedures, or that their coronary anatomy was less amenable to intervention to reopen narrowed or blocked vessels,” Mintias said. Such issues may put them at a higher risk of complications related to the procedure.

“When possible, however, if someone is a suitable candidate, these measures should be considered as options,” he said. “The presence of autoimmune disease in and of itself should not prevent a person from taking life-saving measures.”

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