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Women with any of three common types of autoimmune disease may face a higher rate of death linked to heart disease and stroke than men with the same condition, even as the rates dropped for both groups, a new analysis finds.

Autoimmune disease, in which the immune system attacks the body's own organs, tissues and cells, can contribute to cardiovascular disease. About 27 million people – roughly – live with an autoimmune disease, federal data shows.

The new analysis focused on the most common autoimmune diseases, or immune-mediated inflammatory diseases: rheumatoid arthritis, lupus and systemic sclerosis. Crohn's disease, ulcerative colitis, psoriasis, multiple sclerosis and asthma also are autoimmune diseases. Prior research has shown that heart attack survivors with autoimmune disease were more likely to die, develop heart failure or have another heart attack than those without one of the diseases.

Women are up to three times more likely to have rheumatoid arthritis and about nine times more likely to have lupus than men, according to the Centers for Disease Control and Prevention. Systemic sclerosis, or scleroderma, is a group of rare conditions that also develops more often in women. It is different than multiple sclerosis and involves the tightening and hardening of skin, which can affect the digestive tract, blood vessels and internal organs.

Using data from the CDC's WONDER database, researchers identified 127,149 deaths from 1999 through 2020 linked to cardiovascular disease and the three autoimmune conditions. The death rate among women dropped significantly, from 3.9 deaths per 100,000 to 2.1. But it was still higher than men, whose rate decreased from 1.7 deaths per 100,000 to 1.2.

Stroke and coronary artery disease were the primary causes linked to the deaths of all participants with autoimmune disease, but more women died of these conditions than men. Women also were more than twice as likely to die of an irregular heart rhythm or cardiac arrest, the researchers found.

The rate of death associated with cardiovascular disease among women with rheumatoid arthritis was 1.8 per 100,000 over the study period, three times more than the rate for men. For lupus, the rates were similar: 0.2 deaths per 100,000 for women and 0.1 for men. The death rate for participants with systemic sclerosis was too low to compare, the researchers noted.

The May 5 in the ÃØÃÜÑо¿Ëù journal Circulation: Cardiovascular Quality and Outcomes.

Researchers said understanding the differences between men and women in the rate of cardiovascular death associated with autoimmune disease remains relatively unexplored.

"This study reinforces the need to investigate drivers of these disparities between women and men and how to improve treatment for patients" with autoimmune disease, lead study author Dr. Issam Motairek said in a . Motairek is an internal medicine resident at the Cleveland Clinic.

Advances in treatments for autoimmune and cardiovascular diseases, as well as improvements in the management of the conditions, may help explain the downward trend in the death rate, the researchers said.

They also noted that the CDC data on death rates may be inaccurate due to coding misclassifications in records. The data also did not include information about the participants' other health problems, disease severity and treatments.

Key questions remain, senior study author Dr. Heba S. Wassif said in the news release, about the underlying causes of the disparities among the participants, effective risk-reducing therapies and whether the nature of coronary artery disease differs in people with autoimmune disease that could lead to uncharacteristic presentations and delayed diagnoses. She is an assistant professor at the Lerner College of Medicine at Case Western Reserve University in Cleveland and director of cardio-rheumatology at Cleveland Clinic.

"As we gain a deeper understanding of inflammation's role in cardiovascular disease, we must translate this knowledge into targeted prevention strategies to reduce cardiovascular disease-related deaths in women" with autoimmune disease, Wassif said.