ICYMI: Maintain Vigilance for CV Risk Postpartum in Autoimmune Diseases Save

Pregnant women with autoimmune rheumatic diseases (ARDs) and antiphospholipid syndrome (APS) face significantly increased risks of cardiovascular events (CVEs). This increased risk is often attributed to ARDs, its medications or comorbidities associated with it.

The first plenary presentation at ACR23 (abstract #0722) studied this risk in administrative large-scale data in a comprehensive way. They retrospectively analyzed pregnant individuals who delivered singleton liveborn infants in California between 2005-2020. While cardiovascular diseases complicate 1-4% of pregnancies, individuals with ARDs exhibit a 1.5 to 3-fold higher risk, emphasizing the need for a closer examination of this population. Further, APS is an ARD, which specifically is known as a risk factor for cardiovascular health.

In this study, researchers aimed to compare rates of acute CVEs in pregnant women with ARDs and primary APS to those without these conditions, using a large population-based birth cohort. Approximately nineteen thousand ARD pregnancies were studied with 7 million non-ARD pregnancies as a control group. The findings revealed that 2.0% of pregnant women with ARDs and 6.9% with primary APS experienced CVEs, a stark contrast to the 0.4% in the comparison group. Notably, systemic lupus erythematosus (SLE) demonstrated a six-fold increased risk for CVEs, with further elevations when combined with APS or nephritis.

Moreover, the study delved into postpartum risks, discovering that 25-30% of CVEs occurred in this period, representing a six-fold greater risk compared to the control group. This underscores the importance of continuous monitoring of cardiovascular health not only during pregnancy but also in the postpartum period for women with autoimmune conditions.

These findings offer critical insights into the cardiovascular challenges faced by pregnant women with ARDs and APS, emphasizing the necessity of tailored healthcare strategies to manage and mitigate these heightened risks during and most importantly after pregnancy. In the future we will need risk prediction tools to identify high risk patients and ultimately develop strategies to mitigate the risk.