Autoimmune heart disease: role of sex hormones and autoantibodies in disease pathogenesis

Abstract

Cardiovascular disease (CVD) and autoimmune diseases (ADs) are the first and third highest causes of death in the USA, respectively. Men have an increased incidence of the majority of CVDs, including atherosclerosis, myocarditis, dilated cardiomyopathy and heart failure. By contrast, nearly 80% of all ADs occur in women. However, in one category of ADs, rheumatic diseases, CVD is the main cause of death. Factors that link rheumatic ADs to CVD are inflammation and the presence of autoantibodies. In this review we will examine recent findings regarding sex differences in the immunopathogenesis of CVD and ADs, explore possible reasons for the increased occurrence of CVD within rheumatic ADs and discuss whether autoantibodies, including rheumatoid factor, could be involved in disease pathogenesis.

Keywords::

• autoimmune disease
• cardiovascular disease
• pathogenesis
• rheumatic disease
• sex differences

Financial & competing interests disclosure

D Fairweather and MJ Coronado were supported by funding from the NIH (R01 HL087033 to D Fairweather). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

^†Frequent cause of myocarditis.

Adapted from [84].

CRP: C-reactive protein; LDL: Low-density lipoprotein; Lp(a): Lipoprotein(a); oxLDL: Oxidized low-density lipoprotein; TLR: Toll-like receptor.

Data taken from [11].

SLE: Systemic lupus erythematosus.

Myositis: also called dermatomyositis; Scleroderma: also called systemic sclerosis.

Data taken from [199].

^†Infections that induce myocarditis in humans and/or animal models.

Adapted from [186].

Myositis: also called dermatomyositis; Scleroderma: also called systemic sclerosis.

Data taken from [200].