Heart disease is present in 1 of every 3 people with lupus, and is a common cause of sickness and death. While most people develop it after 10 or more years of having lupus, many are still so young—in their 30s and 40s—that they do not even realize that their hearts can get sick. Taking extra good care of the heart with a healthy diet, regular exercise, and heart medicines when needed can make a big difference.
The most common heart problem in people with lupus is inflammation in the sac around the heart. This can cause shortness of breath and sharp chest pains. Lupus can also directly weaken the heart by causing it to get inflamed. These problems are usually treated with powerful inflammation-fighters and medicines that calm down the immune system, such as corticosteroids like prednisone. (Taking corticosteroids for a long time can worsen heart health, however, so a doctor may want to lower the dose at times.)
See your doctor regularly and always mention new or changing symptoms—including chest pain or shortness of breath. Ask about other warning signs of a heart attack or stroke and what to do if they develop. The goal is to detect and treat lupus flares as early as possible, limit corticosteroid use (in a smart way, with the doctor’s approval), take measures to stop other heart-damaging factors (smoking, high blood pressure, excess weight), get regular exercise (even a 30-minute daily walk helps), and follow a healthy diet. Also key: a close working relationship between you and your doctor, including heart specialists (cardiologists). Some doctors put lupus patients with coronary artery disease on cholesterol-lowering drugs called statins.
More than 1 in 3 people with lupus have coronary artery disease, which can cause chest pain, heart attack, or stroke. With coronary artery disease, the arteries that take blood and oxygen to the heart get inflamed. Because of changes in the immune system caused by lupus, the arteries get stiff and rapidly harden, narrow, and clog. Sometimes the arteries go into spasm. Over time, clots form and bits of cholesterol can break off from the linings of the arteries and get in the way of smooth blood flow to the heart and brain.
Along with a close relationship with a lupus doctor, it is important to see a heart specialist, called a cardiologist, if heart problems develop. A cardiologist may take special pictures of your heart to see if it is healthy or working too hard. This kind of doctor also has a lot of information about smart lifestyle and diet changes, as well as medicines that are best to take for lupus-related high blood pressure and high cholesterol. Lately, many have started recommending that people with lupus take statins, a type of cholesterol drug that appears to lessen inflammation in vessels of the heart as well as in other organs and tissues.
Certain populations, such as African-American women, need to be particularly watchful for heart problems. Not only is heart disease the number one killer of all African-American women, but the death rate from heart disease is much higher in women of color. African-American women are also three times more likely than Caucasian women to have lupus—which in itself raises the risk for heart damage.
Researchers are learning a lot about how and why lupus damages the heart and about the immune system changes that can be so harmful. They are figuring out quicker and easier tests (predictors called “biomarkers”) for seeing if the heart or coronary arteries are getting damaged by lupus, so that treatment can be started right away.
Reviewer: Daniel J. Wallace, MD
Spring 2015
