Autoimmune Skin Disease Raises CV Risk From Adolescence, Congress Hears

Cardiovascular risk in patients with autoimmune diseases begins as early as adolescence — decades before standard risk assessment typically starts at age 40 — according to Brittany Weber, MD, PhD, director of the cardio-rheumatology and cardio-dermatology program at the University of Texas Southwestern Medical Center.

Weber presented the case for cross-disciplinary cardiovascular surveillance at the Cardiometabolic Health Congress Women's Cardiometabolic Health and Wellness Masterclass, held in Boston. Her central claim was direct: dermatologists manage patients whose immune-mediated conditions carry cardiac consequences that current practice fails to capture.

"Cardio-rheumatology and -dermatology is an emerging subspeciality with a focus on better recognition of cardiovascular disease in this inherently higher-risk population," Weber said.

Why did dermatologists start paying attention?

The trigger was trial evidence, not theory. Weber pointed to randomized data showing that the anti-inflammatory agents canakinumab (Ilaris, Novartis) and colchicine delivered cardiovascular benefits. If dampening inflammation reduces CV events, she argued, the chronic inflammation of autoimmune disease plausibly drives them.

That evidence base prompted UT Southwestern to build what Weber described as the first combined cardio-rheumatology and cardio-dermatology program in the United States. The model concentrates on dermatologic conditions that raise cardiac risk.

"It's actually just the premise of focusing on the diseases in dermatology that lead to higher cardiac risk," Weber said. "It's a really exciting time because this is an emerging subspecialty."

A caveat belongs here: the canakinumab and colchicine trials established a principle about inflammation in general populations, not about psoriasis or lupus cohorts specifically. Weber did not present condition-stratified outcome data from her own program in this talk.

How early does the risk appear?

Autoimmune diseases, which are more common in women than in men, increase the risk for CV events and raise the severity of coronary atherosclerosis, Weber said. The phenotype extends beyond atherosclerosis, she cautioned, which complicates any single-mechanism explanation.

The timing gap is the practical problem. Risk may emerge in adolescence, yet assessment often waits until age 40. Weber was blunt about the tools.

"Our CV risk calculators don't estimate disease adequately in the young, and they certainly don't estimate disease in these specific [autoimmune] disease conditions because they don't attribute that disease to CV risk," she said.

In plain terms: a 28-year-old woman with systemic lupus erythematosus will score as low-risk on a conventional calculator regardless of her disease. The calculator simply does not know what lupus is.

What should dermatologists watch?

Coronary microvascular dysfunction — impaired function of the heart's smallest vessels — has elevated prevalence in patients with immune-mediated inflammatory diseases such as psoriasis and systemic lupus erythematosus, Weber said. That dysfunction in turn raises risk for death, myocardial infarction and heart failure.

"Think about this when your patients are presenting with [autoimmune disease] symptoms, and also remember that it is a prognostic biomarker," she said. "When we do imaging studies, a lot of [CV] disease gets detected in these asymptomatic patient populations."

The implication for clinic workflow is concrete: imaging in apparently asymptomatic autoimmune patients frequently finds disease. Weber did not specify which imaging modalities or at what intervals screening should occur — a gap the field will need to fill.

What about dermatologic drugs themselves?

Weber closed on the therapeutic side of the equation. Dermatologists prescribe agents whose cardiac risk profiles are not always appreciated, she suggested, and these add to the baseline risk imposed by the disease.

"These are diseases our patients are presenting to us in clinic, and we need to be thinking about how that can impact their risk," Weber said. "And there's also the therapeutic armamentarium of all the drugs they're utilizing as dermatologists. And some of those can have unique risk profiles associated with cardiac conditions."

She named no specific dermatologic agents in the quoted remarks, so dermatologists seeking guidance on particular drug classes will find no answers here.

The multidisciplinary programs now forming at institutions such as UT Southwestern suggest the next step: shared care pathways in which a psoriasis diagnosis itself, independent of traditional risk factors, triggers cardiovascular evaluation.