For decades, doctors have observed a troubling pattern: patients with autoimmune diseases like rheumatoid arthritis and lupus seem to develop heart disease at alarmingly high rates, often at surprisingly young ages. What was once dismissed as a coincidence has now emerged as one of the most compelling examples of how our immune system, when misdirected, can become our own worst enemy.
The Hidden Connection
Your immune system is a security force designed to protect your body from invaders. In autoimmune diseases, this security force becomes confused and starts attacking your tissues. This can occur for various reasons, such as genetic predisposition, infections, or environmental triggers. The damage doesn’t stop there — emerging research reveals that this internal warfare significantly accelerates atherosclerosis, the buildup of fatty plaques in arteries that leads to heart attacks and strokes.
People with autoimmune diseases face a dramatically increased risk of atherosclerotic cardiovascular disease and its clinical manifestations. This isn’t a small uptick in risk — we’re talking about substantially higher rates of heart disease that traditional risk factors like high cholesterol and blood pressure simply can’t explain.
Beyond Traditional Risk Factors
When cardiologists first noticed this pattern, they naturally looked to traditional explanations. Perhaps autoimmune patients smoked more, had higher cholesterol, or led more sedentary lifestyles? The answer turned out to be far more complex.
Traditional cardiovascular risk factors such as dyslipidemia and hypertension alone do not explain the increased risk of cardiovascular disease associated with autoimmune diseases. Something more fundamental was happening — the very immune dysfunction that drives autoimmune disease was also accelerating atherosclerosis.
The Inflammatory Connection
At the heart of this connection lies chronic inflammation. Think of inflammation as your body’s fire department — essential for putting out biological “fires” but potentially destructive when it never shuts off. In autoimmune diseases, this inflammatory fire burns continuously, and your cardiovascular system gets caught in the crossfire. Adding fuel to this fire is nervous system dysregulation, a common feature of autoimmune conditions where the body’s stress response system becomes chronically activated. The autonomic nervous system, which normally maintains balance between fight-or-flight and rest-and-digest responses, becomes stuck in overdrive. This dysregulation triggers the release of stress hormones like cortisol and activates inflammatory pathways through the hypothalamic-pituitary-adrenal axis, creating a vicious cycle where inflammation begets more inflammation.
In active inflammation, the liberation of inflammatory mediators such as tumor necrotic factor alpha (TNFa), interleukine-6 (IL-6), IL-1 and other factors like T and B cells, play a major role in the atheroma formation. This inflammatory cascade is amplified by nervous system dysfunction, as chronic stress signaling promotes the production of these same inflammatory cytokines while simultaneously impairing the body’s natural anti-inflammatory mechanisms. These inflammatory molecules don’t just damage joints or skin — they transform your blood vessels into battlegrounds where atherosclerotic plaques form and grow, with the dysregulated nervous system acting as a persistent accelerant to this destructive process.
Autoimmunity Meets Atherosclerosis
Perhaps most interesting is that atherosclerosis itself may be a form of autoimmune disease. Oxidized low-density lipoprotein triggers inflammatory and immunogenic events that promote endothelial dysfunction and the synthesis and secretion of pro-inflammatory cytokines, leading to an autoimmune response.
This creates a vicious cycle: autoimmune diseases accelerate atherosclerosis, while atherosclerosis itself becomes an autoimmune process. Your immune system begins attacking modified cholesterol and other components in artery walls, perpetuating inflammation and plaque growth.
The Autoantibody Factor
One of the most distinctive features of autoimmune diseases is the production of autoantibodies — antibodies that mistakenly target your tissues. These wayward antibodies don’t limit their damage to traditional autoimmune targets.
Loss of tolerance to self-antigens and the generation of autoantibodies are key features of autoimmunity but are also implicated in the maladaptive inflammatory response during atherosclerotic cardiovascular disease. Some autoantibodies directly promote atherosclerosis, while others may make existing plaques more vulnerable to rupture — the event that typically triggers heart attacks and strokes.
Understanding the Mechanisms
The relationship between autoimmunity and atherosclerosis involves multiple, interconnected pathways:
Endothelial Dysfunction: The delicate lining of your blood vessels becomes damaged by chronic inflammation, creating the perfect environment for plaque formation.
Aberrant Immune Cell Behavior: Aberrant leukocyte function and pro-inflammatory cytokines are central to both disease entities, resulting in vascular dysfunction, impaired resolution of inflammation and promotion of chronic inflammation.
Oxidative Stress: Autoimmune diseases increase oxidative damage to cholesterol and other lipids, making them more likely to accumulate in artery walls.
Impaired Inflammation Resolution: Perhaps most importantly, the normal mechanisms that shut down inflammation become impaired, allowing chronic inflammation to persist and damage cardiovascular tissues.
Clinical Implications
This understanding has profound implications for patient care. One-third of the mortality associated with autoimmune diseases is due to cardiovascular diseases. This means that managing autoimmune disease isn’t just about controlling joint pain or skin rashes — it’s also about protecting your heart.
For patients with conditions like rheumatoid arthritis or lupus, cardiovascular risk assessment should begin early and be more aggressive than for the general population. Traditional risk calculators may significantly underestimate their true cardiovascular risk. Labs can include a full Lipid Panel, cholesterol particle size test (NMR), including Lipo(a), Homocysteine, Vitamin D, Omega Profile, C-Reactive Protein, and a CT scan of the Coronary Arteries to identify existing plaque buildup. A voluntary scan can be done at Durham Diagnostics locally for just over $100 with no physician order.
Many of the labs listed above can be ordered by a physician and coded to be covered by your standard medical insurance. That said, we also recognize that it takes an average of 5-6 years to get an autoimmune disease diagnosis, so you may not have the bandwidth or energy to advocate for these labs listed above, but we have solutions! We can order these as out-of-pocket labs to be drawn at Labcorp or Quest with surprisingly minimal cost.
Labcorp: $119 + $10 draw fee for Lipid Panel, Particle Profile, Lipo(a), Homocysteine, Vitamin D, C-Reactive Protein
Quest: $50 + $8 draw fee for Omega Profile
Calcium Score: $100 – $150, depending on where you go
Therapeutic Opportunities
The silver lining in this story lies in the therapeutic opportunities it reveals. If chronic inflammation drives both autoimmune disease and accelerated atherosclerosis, then anti-inflammatory treatments might kill two birds with one stone (not that we are in the habit of killing birds).
Immunomodulatory therapies are potential efficacious interventions to directly reduce the risk of cardiovascular disease. Some medications used to treat autoimmune diseases, particularly those targeting key inflammatory pathways, may simultaneously reduce cardiovascular risk.
Early studies with anti-inflammatory medications specifically for cardiovascular disease have shown promise, suggesting that lessons learned from autoimmune disease management could benefit the broader population at risk for heart disease.
Methylated Folate and Vitamin B12 can support the one-carbon metabolism pathway to lower Homocysteine levels to lower cardiovascular risk.
Grounding mats and sheets represent a practical indoor application of earthing therapy that shows promise for reducing inflammation in individuals with autoimmune conditions. Grounding could serve as “the anti-inflammatory antidote for modern man” and may be particularly important in preventing inflammatory illness, which forms the foundation of most autoimmune disorders. Research demonstrates that earthing stabilizes the physiology at the deepest levels, reduces inflammation, pain, and stress while improving blood flow and generating greater well-being. Medical infrared imaging has documented significant reductions in inflammation when individuals sleep grounded, with thermal imaging cameras showing decreased hot areas indicative of inflammation. Healthcare practitioners report seeing improvements in autoimmune disorders like Graves’ disease, lupus, multiple sclerosis, and rheumatoid arthritis with earthing interventions, with thermography confirming the healing process through visible reductions in inflammation hotspots. The underlying mechanism appears to involve the Earth’s electrons neutralizing reactive oxygen species and free radicals that contribute to chronic inflammation, with research suggesting this approach provides simple and reliable help for those with these health issues. Grounding systems in the form of sheets and mats enable sustained contact with the Earth’s healing properties while sleeping or sitting, making this anti-inflammatory intervention accessible for daily use in managing autoimmune conditions. This $30 mat from Amazon works really well, so no need to break the bank on expensive sheets or shoes: https://www.amazon.com/dp/B07VSRK68V?ref=ppx_yo2ov_dt_b_fed_asin_title&th=1
The Future of Prevention
Looking ahead, this research suggests we need to rethink cardiovascular disease prevention. Rather than focusing solely on cholesterol levels and blood pressure, we may need to consider inflammatory markers and immune function as equally important targets.
Biomarkers of autoimmune disease activity could be relevant tools to stratify patients with autoimmunity according to their cardiovascular risk. This could enable more personalized, precise approaches to cardiovascular prevention in high-risk populations.
A New Paradigm
The connection between autoimmune diseases and accelerated atherosclerosis represents more than just an interesting medical observation — it’s fundamentally changing how we understand cardiovascular disease. Rather than viewing heart disease as simply the result of “wear and tear” or lifestyle choices, we’re beginning to appreciate it as an immune-mediated inflammatory condition.
The story of autoimmunity and atherosclerosis reminds us that the human body is an interconnected system where dysfunction in one area can have far-reaching consequences. For patients living with autoimmune diseases, this research brings both sobering awareness of cardiovascular risk and empowerment to be proactive in your cardiovascular health with labs and scans that provide you as much information as early on as possible so we can work together to reduce your risk of accelerated atherosclerosis. As our understanding deepens, the prospect of preventing the cardiovascular complications that too often accompany autoimmune diseases becomes increasingly realistic.
Chevalier, G., Sinatra, S. T., Oschman, J. L., Sokal, K., & Sokal, P. (2012). Earthing: health implications of reconnecting the human body to the Earth’s surface electrons. Journal of environmental and public health, 2012, 291541. https://doi.org/10.1155/2012/291541
Jamieson I. A. (2023). Grounding (earthing) as related to electromagnetic hygiene: An integrative review. Biomedical journal, 46(1), 30–40. https://doi.org/10.1016/j.bj.2022.11.005
Liu, C., Dhindsa, D., Almuwaqqat, Z., Sun, Y. V., & Quyyumi, A. A. (2022). Very High High-Density Lipoprotein Cholesterol Levels and Cardiovascular Mortality. The American journal of cardiology, 167, 43–53. https://doi.org/10.1016/j.amjcard.2021.11.041
Menigoz, W., Latz, T. T., Ely, R. A., Kamei, C., Melvin, G., & Sinatra, D. (2020). Integrative and lifestyle medicine strategies should include Earthing (grounding): Review of research evidence and clinical observations. Explore (New York, N.Y.), 16(3), 152–160. https://doi.org/10.1016/j.explore.2019.10.005
Sinatra, S. T., Sinatra, D. S., Sinatra, S. W., & Chevalier, G. (2023). Grounding – The universal anti-inflammatory remedy. Biomedical journal, 46(1), 11–16. https://doi.org/10.1016/j.bj.2022.12.002
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