Cardiovascular Implications of Immune Disorders in Women

• Type of Material: Article
• Authors: Caitlin Moran, Emory University; Lauren Collins, Emory University; Nour Beydoun, Emory University; Puja Mehta, Emory University; Yetunde Fatade, Emory University; Ijeoma Isiadinso, Emory University; Tene Lewis, Emory University; Brittany Weber, Harvard Medical School; Jill Goldstein, Harvard Medical School; Ighovwerha Ofotokun, Emory University; Arshed Quyyumi, Emory University; May Y Choi, University of Calgary; Kehmia Titanji, Emory University; Cecile Lahiri, Emory University
• Language: English
• Date: 2022-02-18
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCRESAHA.121.319877
• Title of Journal or Parent Work: CIRCULATION RESEARCH
• Volume: 130
• Issue: 4
• Start Page: 593
• End Page: 610
• Grant/Funding Information: C.A.M is supported by NIH/NHLBI K23HL152903. L.F.C is supported by the National Center for Advancing Translational Sciences (NCATS) of the NIH (award numbers UL1TR002378 and KL2-TL1TR002381). N.B and Y.F are supported by the Stimulating Access to Research in Residency of the National Institutes of Health (NIH) under Award Number R38AI140299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. T.T.L is supported by NIH/NIAMS R01 AR070898. B.W is supported, in part, by an American Heart Association Career Development Grant (Dallas, TX) CDA 851511, and NIH (Bethesda, MD) K23 HL159276-01. M.Y.C is funded by the Lupus Foundation of America Gary S. Gilkeson Career Development Award. K.T. is supported by NIH/NHLBI R03 5R03HL154829-02. C.A.M, A.Q, P.K.M, I.O, and C.D.L are funded, in part, by NIH/NIA U54 AG062334 (Emory Specialized Center of Research Excellence in Sex Differences); C.D.L is also supported by NIH/NIAID K23 AI124913. This work was further supported by the Emory Center for AIDS Research (P30-AI-050409)
• Keywords: immune system diseases; women; Cardiac & Cardiovascular Systems; Peripheral Vascular Disease; risk factors; ESTROGEN-RECEPTOR-BETA; Hematology; HIV-INFECTED WOMEN; ACUTE MYOCARDIAL-INFARCTION; T-CELL-ACTIVATION; Cardiovascular System & Cardiology; PITUITARY-ADRENAL RESPONSE; Science & Technology; cardiovascular diseases; Life Sciences & Biomedicine; HEPATITIS-C VIRUS; 2013 AMERICAN-COLLEGE; inflammation; SEX-DIFFERENCES; CORONARY-ARTERY-DISEASE; SYSTEMIC-LUPUS-ERYTHEMATOSUS

Abstract

Immune responses differ between men and women, with women at higher risk of developing chronic autoimmune diseases and having more robust immune responses to many viruses, including HIV and hepatitis C virus. Although immune dysregulation plays a prominent role in chronic systemic inflammation, a key driver in the development of atherosclerotic cardiovascular disease (ASCVD), standard ASCVD risk prediction scores underestimate risk in populations with immune disorders, particularly women. This review focuses on the ASCVD implications of immune dysregulation due to disorders with varying global prevalence by sex: autoimmune disorders (female predominant), HIV (male-female equivalent), and hepatitis C virus (male predominant). Factors contributing to ASCVD in women with immune disorders, including traditional risk factors, dysregulated innate and adaptive immunity, sex hormones, and treatment modalities, are discussed. Finally, the need to develop new ASCVD risk stratification tools that incorporate variables specific to populations with chronic immune disorders, particularly in women, is emphasized.