TOPLINE

Autopsies of patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) found their hearts were more often enlarged, scarred, and inflamed than those of people killed in motor vehicle crashes. Some of these differences were more prominent in patients younger than 60 years. Heart scarring, enlargement, and coronary artery disease (CAD) were also tied to cardiovascular deaths in both conditions.

METHODOLOGY

• Researchers conducted a case-control postmortem study of heart pathology using Australian coronial records from 2000 to 2025.
• The analysis included 486 people: 240 patients with RA, 123 with SLE, and 123 who died in motor vehicle crashes. Median age was 63 years among patients with SLE or RA and 59 years among the crash victims, and 69.1% of patients and 74.8% of crash victims were women.
• Adults with RA or SLE were identified through keyword and diagnostic code searches of coronial records and needed an autopsy report that included a heart examination. Crash victims were excluded if a medical episode may have caused the crash or chest injuries prevented the heart from being examined.
• Heart weight, visible heart findings, and tissue analysis were extracted from autopsy reports using standardized definitions. Cardiomegaly, commonly known as an enlarged heart, was defined as heart weight above the 95th percentile for body weight. Significant CAD was defined as narrowing of 50% or more in a coronary artery or a lesion described as at least moderate.
• Statistical models adjusted for age, sex, and BMI were used to compare findings between patients and crash victims and to test their links to cardiovascular death and sudden cardiac death.

TAKEAWAY

• Compared with crash victims, a higher proportion of patients with SLE or RA had enlarged hearts (46.6% and 49.6%, respectively, vs 18.6%), heart muscle scarring (57.9% and 75.8%, respectively, vs 39.0%), and heart muscle inflammation (20.2% and 8.8%, respectively, vs 1.6%).
• After adjustment, the odds of an enlarged heart were 5.7 times as high in SLE and 3.5 times as high in RA. The odds of heart muscle scarring, heart muscle inflammation, and significant CAD were also notably higher. Enlarged hearts and heart muscle scarring remained more common in both conditions after further adjustment for CAD.
• In an unadjusted analysis of patients younger than 60 years, the odds of enlarged hearts and heart muscle scarring were even higher in both SLE and RA, whereas heart muscle inflammation was significantly more common in SLE only.
• Cardiovascular death accounted for 51.2% of deaths in patients with SLE and 56.3% in those with RA. After adjustment, enlarged hearts, heart muscle scarring, and significant CAD were each linked to cardiovascular death in both conditions. CAD was also linked to sudden cardiac death in both.

IN PRACTICE

"[T]hese data underscore the need for more sensitive, non-invasive methods of risk-stratifying individuals with autoimmune disease, particularly younger individuals at risk of premature cardiovascular disease," the authors wrote.

SOURCE

This study was led by Jessica L. Fairley, MBBS, PhD, The University of Melbourne, Melbourne, Australia. It was published online on October 15 in The Journal of Rheumatology.

LIMITATIONS

Coroner-ordered autopsies likely favored sudden or unexplained deaths, and crash victims may have had less heart disease than the general population. The authors could not independently confirm diagnoses or assess impact of treatments such as corticosteroids. The study also had no information from before death.

DISCLOSURES

No specific funding was received. Some authors reported personal support through fellowships and grants from the Royal Australasian College of Physicians, Australian Rheumatology Association, Avant Foundation, and other sources. Four authors reported consulting, honoraria, or speaker fees from pharma companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.