Comparative Cardiovascular Risk Index Across Autoimmune Conditions in a Large Middle-East Health System

Abstract Autoimmune diseases confer excess cardiovascular disease (CVD) risk, yet comparative profiles across phenotypes in Gulf health systems are unclear. Using routinely collected primary-care records, we analyzed 14,616 adults and derived a composite CVD risk index from a Framingham-based algorithm; “high risk” was the cohort upper quartile. Between-group differences were tested by Kruskal–Wallis with Benjamini–Hochberg–adjusted Dunn tests, and multivariable logistic (high risk) and linear (continuous index) models adjusted for body mass index (BMI), log-transformed ESR and CRP, and statin use; index components were not re-introduced. The proportion above the high-risk threshold differed by group—rheumatoid arthritis (RA) 29.4%, no autoimmune 25.7%, multiple-autoimmune 23.9%, systemic lupus erythematosus (SLE) 19.8%, and Hashimoto’s 12.7%—with a significant omnibus test (H=68.6, df= 4, p<10⁻¹³). Relative to the non-autoimmune reference, adjusted odds of high risk were higher in RA (OR 1.20, 95% CI 1.06–1.37), lower in Hashimoto’s (0.49, 0.40–0.60), and not clearly different in SLE (0.80, 0.62–1.02) or multiple-autoimmune phenotypes (1.00, 0.56–1.71). In linear models, group coefficients were small, whereas higher BMI, ESR, and statin use were positively associated with the index. In this real-world cohort, RA carried a modestly higher composite CVD risk than non-autoimmune patients, whereas Hashimoto’s showed a lower burden, supporting systematic CVD risk assessment and targeted management—particularly blood-pressure control and weight/inflammation control—in autoimmune populations within Gulf health systems.