Lupus and heart disease




Having inflammatory types of rheumatic disease such as lupus means that you’re at a higher risk of having a heart attack, stroke, or other serious cardiovascular issue.

As many of you will already know, lupus is one of the trickiest autoimmune diseases to diagnose because it can impact so many different parts of the body. Lupus has the potential to cause system-wide damage, including to your heart and blood vessels. Cardiovascular disease is common among people with lupus. Studies have found that lupus patients are at least twice as likely as members of the general population to develop it.


In general, heart disease risk increases as you get older, but for people with lupus the increased risk starts young.


Lupus patients of all ages have an increased heart attack risk compared to the general population, but women age 35 to 44 with lupus are 50 times more likely than women without lupus to have a heart attack. Therefore, it is important to learn what steps you can take to protect yourself.


Types of Cardiovascular Problems in Lupus


Around 50% of lupus patients develop some type of heart problem. The most common ones are:


Pericarditis The membrane around the heart becomes swollen, which causes fluid to leak out around the heart. About 25% of people with systemic lupus erythematosus (SLE), the most common kind of lupus, develop pericarditis.


Endocarditis This refers to the build-up of growths on the surface of heart valves. It’s more common in lupus patients who have antiphospholipid antibodies (more on this below), and it’s a major risk factor for infection and stroke. About 15 percent of SLE patients experience this problem.


Myocarditis This is an inflammation of the heart muscle itself. It often causes a rapid heartbeat and enlargement of the heart. People with lupus may also develop rhythm disorders (arrhythmias), a rapid accumulation of fatty plaque in their arteries (accelerated atherosclerosis), and blood clots that could lead to a stroke, heart attack, or pulmonary embolism (which most often occurs when a blood clot from the deep veins in the legs travels to the lungs).


Why Lupus May Harm Your Heart


Although research is ongoing, there are several reasons lupus and cardiovascular diseases often overlap.


Inflammation


The inflammatory, autoimmune nature of lupus can cause issues throughout the body, including in your blood vessels and the tissues in and around your heart. Lupus-related inflammation can also make these fatty plaques more likely to rupture, form a clot, and travel to the head or heart, causing a stroke or heart attack.


Blood clotting


About half of all lupus patients have antiphospholipid antibodies, which attack a specific part of cell membranes. There are a few different types of these antibodies, including lupus anticoagulant and anticardiolipin antibodies. Antiphospholipid antibodies inflame blood vessels and make your blood more likely to clot inappropriately. While not all blood clots are equally dangerous, some can lead to a potentially fatal pulmonary embolism, stroke, or heart attack.


Hypertension and/or High Cholesterol


Around half of all lupus patients have high blood pressure which increased the risk of stroke.

Some lupus patients have “dysfunctional” HDL, which causes more inflammation and further contributes to the build-up of fatty plaque in the arteries.


Medication


The biggest offenders are steroids like prednisone and methylprednisolone, which are often used to control lupus flares. Flares themselves can be bad for your heart; it’s not unusual to develop pericarditis in the midst of a flare. However, the steroids used to control very active disease may also be problematic. These drugs can raise your blood pressure, cholesterol, and blood sugar. The longer you are on these drugs and the higher the dose, the greater the risk to your cardiovascular system. Low doses of steroids for a short period of time aren’t nearly as problematic for your heart.


Kidney Disease or Type 2 Diabetes


Lupus often damages the kidneys, causing a problem called lupus nephritis. You need your kidneys to filter out waste from your body but it can also bad for your heart. When your kidneys aren’t working properly, the heart has to pump more blood to them. Lupus is also linked to a higher risk of type 2 diabetes, which is a significant risk factor for cardiovascular disease.


How to Lower Your Heart Disease Risk


Talk to your rheumatologist or a cardiologist and make sure one of them is keeping a close eye on your cardiovascular health.


Starting with risk assessments like blood pressure, cholesterol, and blood sugar should be measured regularly in patients with lupus. Your doctor should use the findings from these tests, along with other information about your general health.  


Take your medications as prescribed


As with other inflammatory conditions, high disease activity in lupus often correlates with a higher risk of cardiovascular disease. Working closely with your doctor and taking your medications as directed should help.


Tackle traditional heart disease risk factors


While you can’t change the fact that you have lupus, there are several cardiovascular disease risk factors that you can control. You can avoid smoking, try to get yourself to your ideal weight, watch your cholesterol through diet (and medication when indicated), and develop an aerobic exercise programme if you are able to.


If you’re having trouble exercising because of joint discomfort, consider seeing a personal trainer who has experience working with people with lupus.


This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.


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