CardioRheum: Mostly Women But Men Can Get It Too, How Autoimmune Diseases Can Heighten Vascular Risk

Presenter: Michael Garshick, MD, MS

Dr. Michael Garshick, NYU Langone Health, spoke on cardio-rheumatology and vascular risk, framed within the context of sex-specific cardiovascular risk factors.

He narrowed the broad scope of the lecture to the three most common autoimmune inflammatory conditions with a sex-specific emphasis, including rheumatoid arthritis, systemic lupus erythematosus, and psoriasis/psoriatic arthritis.  He proposed a commonality among these conditions is an activated platelet phenotype and discussed this concept of platelet activation and how it affects vascular risk, using psoriasis as a model.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease. It is known to commonly affect the joints but has an impact on systemic vasculature as well. As much as 1% of the U.S. population is affected, and it is twice as common in women compared with men. Cardiovascular mortality is approximately 50% higher in those with this condition compared with those without.1

Another predominantly, but not entirely, female disease is systemic lupus erythematosus. Age of onset is primarily between 16 and 55 years, the condition is up to 15 times more common in women than in men, and there is a 2 to 10 times higher rate of atherosclerotic cardiovascular disease in those with this condition compared with those without.2

Psoriasis/psoriatic arthritis has a bimodal age distribution with age of onset peaking from 30 to 39 and 50 to 59 years. It affects 2 to 3% of the population, and women are as equally affected as men. On average, cardiovascular disease is 50% higher in those who have this compared with those who don’t.3

While no gender differences exist between men and women in psoriasis, there is some data to suggest that women with the condition are more impacted than are men. Analysis has shown that the odds of having a co-existing cardiovascular co-morbidity, in addition to coronary artery disease, are from 3- to 5-fold higher in women with psoriasis compared with women without, while in men psoriasis only increased the odds of a co-existing cardiovascular co-morbidity or coronary artery disease 1 to 2 fold.4 Dr. Garshick said, “In summary, these data highlight a connection between co-existing autoimmune auto-inflammatory conditions and vascular health in men but also particularly in women.”

When exploring mechanisms and biomarkers of cardiovascular risk across these autoimmune and auto-inflammatory conditions, there’s a consistent relationship between disease activity and arterial inflammation.

Fundamentally, it is known that atherosclerosis develops through dyslipidemia, immune cell activation and endothelial activation and damage. “We’ve now come to realize,” said Dr. Garshick, “that platelets and platelet activation are intimately involved in the process of atherosclerosis as well as atherothrombosis.” He and his group used a psoriasis model to explore platelet activation further, and some of the results were shown.3 With platelet RNA sequencing, it was noted that COX-1, which is preferentially inhibited by aspirin, is upregulated in those with moderate to severe psoriatic disease compared with mild disease and controls.5

Dr. Garshick summarized, saying, “Vascular risk and inflammation is present across autoimmunity. Platelet activation may be playing a role in this process, and platelet inhibition with aspirin is an exciting possibility to reduce vascular endothelial inflammation, at least in psoriasis.

Michael Garshick, MD, MS, reports he has no relevant financial relationships to disclose.

Reference

  1. Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K. Rheumatoid arthritis. Nat Rev Dis Primers. 2018 Feb 8;4:18001. doi: 10.1038/nrdp.2018.1. PMID: 29417936.
  2. Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, Ruiz-Irastorza G, Hughes G. Systemic lupus erythematosus. Nat Rev Dis Primers. 2016 Jun 16;2:16039. doi: 10.1038/nrdp.2016.39. PMID: 27306639.
  3. Garshick MS, Ward NL, Krueger JG, Berger JS. Cardiovascular Risk in Patients With Psoriasis: JACC Review Topic of the Week. J Am Coll Cardiol. 2021 Apr 6;77(13):1670-1680. doi: 10.1016/j.jacc.2021.02.009. PMID: 33795041.
  4. Garshick MS, Vaidean G, Nikain CA, Chen Y, Smilowitz NR, Berger JS. Sex differences in the prevalence of vascular disease and risk factors in young hospitalized patients with psoriasis. Int J Womens Dermatol. 2019 May 18;5(4):251-255. doi: 10.1016/j.ijwd.2019.05.003. PMID: 31700981; PMCID: PMC6831767.
  5. Garshick MS, Tawil M, Barrett TJ, Salud-Gnilo CM, Eppler M, Lee A, Scher JU, Neimann AL, Jelic S, Mehta NN, Fisher EA, Krueger JG, Berger JS. Activated Platelets Induce Endothelial Cell Inflammatory Response in Psoriasis via COX-1. Arterioscler Thromb Vasc Biol. 2020 May;40(5):1340-1351. doi: 10.1161/ATVBAHA.119.314008. Epub 2020 Mar 5. PMID: 32131611; PMCID: PMC7180109.

← Back to ACC 2021 Articles