Recent research on sex discrepancies in immune-mediated inflammatory diseases (IMIDs) reveals that despite advancements in cardiovascular care, women with IMIDs face a markedly higher risk of cardiovascular death compared to men.
Cardiovascular mortality in patients with immune-mediated inflammatory diseases (IMIDs) has declined over the past two decades; however, sex-based differences persist. From 1999 to 2020, age-adjusted mortality rates for women decreased from 3.3 to 1.4 per 100,000, while rates for men declined from 2.3 to 1.1 per 100,000. Despite these improvements, women consistently exhibited higher mortality rates than men throughout the study period. Unique hormonal influences on endothelial function, combined with variations in inflammatory response, may contribute to the observed gap between male and female patients. However, these mechanisms remain hypotheses pending further research. Earlier findings have highlighted persistent sex disparities in cardiovascular care that standard risk assessment tools often fail to capture for women with IMIDs.
Recent evidence suggests that improvements in early diagnosis and risk-factor management have been central to the overall decline in IMID-associated cardiovascular deaths across conditions such as rheumatoid arthritis and systemic lupus erythematosus. Data on factors influencing the decline in mortality point to more aggressive lipid-lowering strategies and tighter blood pressure control. However, these gains have not translated equally: women continue to present with atypical cardiac symptoms and are less likely to receive guideline-directed therapies, a trend noted in the earlier report on persistent sex disparities.
Tailoring clinical practice to the specific needs of women with IMIDs requires a multifaceted approach. Optimizing screening protocols to include sex-specific biomarkers, enhancing patient education around symptom recognition, and reinforcing adherence to immunomodulatory and cardiovascular medications are critical steps. As the field advances, multidisciplinary collaboration between rheumatology, cardiology, and primary care will be instrumental in developing sex-specific guidelines.
Key Takeaways:- Women with IMIDs experience higher cardiovascular mortality, underscoring the need for sex-specific risk assessment and management.
- Hormonal and inflammatory differences contribute to persistent disparities despite overall improvements in care.
- Modifiable risk factors—such as treatment adherence and access to multidisciplinary care—offer actionable opportunities to narrow the mortality gap.