Lupus & Cardiovascular Disease

Many studies have shown that people with lupus are at an increased risk of cardiovascular disease. In fact, one study that is referenced by the Lupus Research Alliance notes that women with lupus between 35-45 years old are 50x more likely to have a myocardial infarction (also known as a heart attack). For people with lupus not in that demographic range, the risk is increased 7- to 9-fold.

(This study used the Framingham Heart Study as a comparator. This study began in 1948 and followed 3 generations of people to understand how cardiovascular health impacts the rest of the body. It identified that high blood pressure and high blood cholesterol are major risk factors of cardiovascular disease, and has lead to around 3,000 research publications.)

Subsequent studies have explored the connection between lupus and cardiovascular disease have found similar, although typically less severe, links. One found that people with lupus were twice as likely to have cardiovascular disease as control participants. This is worrisome because it is a leading causes of mortality for people with lupus.

Recent efforts by researchers at the National Institute of Arthritis and Musculoskeletal and Skin Diseases may have identified the reason for the increased cardiovascular risk for Lupus Warriors. The researchers found that the improperly functioning immune system cells that are a hallmark of lupus (and other autoimmune diseases) also damage cells in the arteries of the heart.

Unfortunately, common medications for the treatment of lupus including immunosuppressants and corticosteroids include side effects. A 2009 study highlighted how these medications may increase blood pressure, cholesterol, and body mass.

With regard to medications, the Lupus Foundation of America shares that it is safe to take most high blood pressure medications with lupus (except for hydralazine “which has been shown to induce activation of T cells and is known to cause drug-induced lupus”). Check with your lupus treatment team if you have any questions or concerns about your medications.

What is Cardiovascular Disease?

Cardiovascular disease is a broad term used to describe all types of diseases or afflictions of the heart and blood vessels. In general, these are conditions that involve the narrowing or blocking off blood vessels. This includes:

• Coronary heart disease (clogged arteries)
• Chest pain (angina)
• Strokes
• Atherosclerosis
• Pericarditis
• Endocarditis
• Congenital heart defects
• Peripheral artery disease

 

Each year in the United States, about 1 in 3 deaths is caused by cardiovascular disease. It is extremely important to be aware of the risk factors

Specific Cardiovascular Diseases & Lupus

Atheroscloerosis

Frequency with SLE: Most common manifestation of cardiovascular disease

What it is: Accumulation of plaque and cholesterol in the arteries. When the plaque hardens, it restricts blood flow to the heart and brain.

Contributing factors: Smoking; obesity; high blood pressure

 

Pericarditis

Frequency with SLE: About 25% of people with lupus

What it is: Pericardium (the membrane around the heart) swells, becomes irritated, and leaks fluid

Symptoms: Pain in the chest that is worse when lying down

Treatment: Often NSAIDs or steroids

 

Endocarditis

Frequency with SLE: About 15% of people with lupus (Libman-Sacks endocarditis)

What it is: Growths (known as vegetations) on the heart valves that can lead to infection and stroke.

Treatment: Anticoagulants

NOTE: When receiving dental work, it is possible for bacteria to pass through the blood and exacerbate this risk. Speak with a doctor prior to seeing a dentist if you have a severe heart murmur.

 

Myocarditis

Frequency with SLE: Less than 10% of people

What it is: Rapid heart beat, chest pains, and an enlarged heart that weaken the heart

Treatment: Closely monitored by a doctor and treated with high dose steroids

5 Strategies to Reduce Cardiovascular Disease Risk

1. Eat a healthy diet
   • 3 – 5 portions of fruit and vegetables everyday
   • Eat whole grain, high-fiber foods
   • Limit alcohol
2. Exercise regularly
   • Be sure to not over-do it and to clear it with your lupus treatment team
3. Stop smoke tobacco
4. Maintain a healthy BMI (body mass index)
5. Monitor and work to reduce your blood pressure if it is over 120/80 mmHg