Skin Rashes and Cardiovascular Disease: Is There a Link? Having one autoimmune disease leads to another, and another... and new cases are on the rise

Autoimmune disease is an etiology—a root cause—of many common diseases, including some that are rare, in which the body’s immune system malfunctions and attacks healthy organs, cells and tissues, including the heart. According to the American Autoimmune Related Diseases Association, there are now over 100 identified autoimmune diseases, including:

  • psoriasis/psoriatic arthritis
  • lupus
  • type 1 diabetes
  • multiple sclerosis (MS)
  • rheumatoid arthritis (RA)
  • inflammatory bowel disease
  • celiac disease
  • Hashimoto’s thyroiditis
  • Graves’ disease
  • myasthenia gravis
  • chronic Lyme disease
  • Addison’s disease
  • fibromyalgia

The prevalence of autoimmune diseases is increasing at an estimated rate of between 3% and 9% every year; currently more than 24 million Americans have been diagnosed with some form of autoimmune disease. What’s most alarming is that a study published in the journal Arthritis & Rheumatology in April 2020 showed that adolescents 12-19 years old were among those that showed a significant increase—the largest increase of all groups in the study of over 14,200 people—in the presence of antinuclear antibodies (ANA), a common biomarker for autoimmunity. Researchers considered this “concerning” and believe it may be indicative of a possible increase of autoimmune disorders in the future.

While conventional medicine treats autoimmune diseases with symptom management, it doesn’t cure their root causes, which means that even if symptoms are minimized, the core problem of the disease still remains. Because the root of the autoimmune disease itself is not being reversed or controlled, it can lead to other health problems including cardiovascular disease (CVD).

The Link Between Autoimmune Diseases and CVD

Since different autoimmune diseases affect different areas of the body—psoriasis impacts the skin, RA attacks the joints, Hashimoto’s targets the thyroid, and so on—is there a commonality between autoimmune diseases in general and cardiovascular disease? The answer is yes—it’s inflammation, a common factor in most health conditions and disorders. In addition, although individual autoimmune diseases impact different areas of the body, they can be systemic disorders. For example, psoriasis shows up on the skin and is thought of as a skin disorder, but it’s actually an inflammatory and immune-mediated problem, which are the actual underlying causes that increase the risk of CVD. This is why simply treating the skin lesions with medications and moisturizers to lessen discomfort and appearance won’t cure the actual cause of the problem.

Cardiovascular disease is considered a secondary, or downstream, effect of autoimmune disease, meaning that whatever primary effect each specific autoimmune disease exhibits (i.e., psoriasis causing thick, scaly skin patches or rheumatoid arthritis causing joint swelling and deformity), an increased risk of heart disease can be yet another effect that is secondary but potentially life-threatening.

Atherosclerosis, one type of coronary artery disease and a main cause of CVD, was for many decades considered a degenerative disease that was an inevitable part of aging. However, research has shown that it is neither inevitable nor degenerative. Rather, it is an autoimmune-inflammatory disease with factors that lead to immune system activation, a consequence of which is the narrowing of arteries, deterioration of artery walls due to an accumulation of scar tissue and fatty deposits, and a proliferation of smooth-muscle cells.

A recent meta-analysis by the National Institutes of Health found that “many reports have been focused on the immunologic background of [atherosclerosis], and it is no longer in doubt that it shares several autoimmune pathways. It is not surprising to find an accelerated [atherosclerosis] in quite a lot of [autoimmune diseases].” In addition, an article in the American Heart Association Journals definitively states, “The risk of CVD is very high in a prototypic autoimmune disease, systemic lupus erythematosus (SLE), and is also raised in other autoimmune diseases such as rheumatoid arthritis.”

The Functional Medicine Perspective

Many conventional medicine doctors agree with their functional medicine counterparts that a healthy lifestyle and diet low in sodium, sugars, processed foods, etc. coupled with regular exercise can help lower the risk of autoimmune and cardiovascular diseases. After that, the two generally part ways:

Conventional medicine treats symptoms and manages dietary considerations on a macro level; it manages the disease progression using pharmaceuticals, and waits for new disease pathways, potentially more acute, to present that are more actionable
Functional medicine searches for root causes that are systemic, that can be targeted using small dietary, lifestyle and nutraceutical interventions, in order to reverse or minimize disease. The goal is to halt the progression and eliminate new pathways, using more natural means and giving the body what it needs to help itself.

While prescription medications are certainly necessary in emergency situations and may need to continue being taken for certain health issues, health problems including autoimmune disease and cardiovascular disease do not occur in isolation or suddenly appear for no reason—there was one or more triggers or a buildup over time that created the problems. Health issues are the result of something going awry in the body—this is the root cause that must be uncovered and addressed in order for optimal health to be achieved and to avoid further complications. Sometimes health problems like diabetes may not be completely reversible (although functional medicine practitioners have achieved reversal in some cases), but they can be improved so that medications can be eliminated and/or their levels reduced to a less risky level through an integrative approach.

One of the problems with long-term medication use is that it can cause a myriad of other problems—just one example is that there are more than 35 medications known to cause “drug-induced lupus”. Conditions that are treated with immunosuppressants (many times used post-transplant and to control inflammatory diseases), which literally suppress the immune system, leave patients open to more easily contracting viruses and other infectious diseases.

Many medications cause even more inflammation in the body, which leads to more disease and/or the addition of new prescriptions. Since inflammation is one of the commonalities between autoimmune disease and CVD, it’s easy to see how this vicious cycle of inflammation and increased disease can occur.

Oxidative stress is another factor that causes both autoimmune diseases and CVD; oxidative stress is an imbalance between the production of free radicals (unstable and highly reactive molecules) and antioxidants—this imbalance can cause disease and damage cells. Research published in the peer-reviewed journal Oxidative Medicine and Cellular Longevity states that oxidative stress and inflammation can lead to hypertension, arteriosclerosis, mitral valve prolapse, and other conditions that, in turn, lead to stroke and other heart disease. Oxidative stress and inflammation are also associated with such metabolic disorders as diabetes, obesity, and hypertension, which can bring about heart failure, diastolic dysfunction, and left ventricular hypertrophy (when the heart’s main chamber has thickened and isn’t pumping efficiently). In short, oxidative stress is a major contributor to vascular disease.

Similarly, an article published by the National Institutes of Health states that oxidative stress also plays an important role in leading to autoimmune disease “by enhancing the inflammation, inducing apoptotic cell death [known as “cellular suicide”], and breaking down the immunological tolerance. When the state of oxidative stress was investigated in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren’s syndrome (SS)…most subjects were in excessive oxidative stress or in defective antioxidant potentials.”

Rather than targeting the symptoms and diseases caused by oxidative stress, functional medicine will work with patients to reverse oxidative stress itself in order to correct the actual cause of the resulting autoimmune diseases and CVD. By doing this as well as discovering any other lifestyle or medical issues that may be contributing to inflammation, autoimmune issues and CVD, additional diseases and furthering of symptoms can be prevented, and existing conditions may even be reversed.