March 25, 2016
How does lupus affect the heart?
Lupus can affect the heart in many ways.
One of the most common ways that lupus affects the heart is pericarditis. Pericarditis is inflammation of the outer lining around the heart. This can sometimes result in the accumulation of fluid around the heart. Signs and symptoms of pericarditis can include sharp stabbing chest pains, often in the middle or left side of the chest, and sometimes in one or both shoulders. The pain often improves when you sit up and lean forward, and may feel worse when you lie down or take a deep breath. You may also experience palpitations (irregular heart beat). Your doctor might also hear rubbing of the inflamed pericardium using a stethoscope. Pericarditis can usually be diagnosed by your doctor with an EKG or an ultrasound of the heart (echocardiogram). Treatments for pericarditis include NSAIDs, prednisone, and sometimes colchicine.
There are other less common ways that active lupus can affect the heart. Lupus can cause problems with the valves of the heart (endocarditis), which in mild cases causes no symptoms other than a heart murmur. Lupus can also cause inflammation of the heart muscle itself, called myocarditis. Myocarditis can cause the heart to have difficulty pumping blood effectively. Symptoms of myocarditis and severe heart valve problems can include shortness of breath, (often worse with exercising or lying down) and swelling in the legs. If your doctor suspects myocarditis or endocarditis, they may perform blood tests, and EKG, and a heart ultrasound. Myocarditis is usually treated with steroids and other immune suppressants.
Patients with lupus also have an increased risk of atherosclerosis (thickening of the arteries). Atherosclerosis can lead to heart attacks and strokes. Patients with lupus are at least twice as likely to have atherosclerosis as people without lupus. Heart attacks and strokes can occur at any age in patients with lupus—for example, although young women aged 34-44 are typically thought to be low risk for heart disease, lupus patients in that age group are 50 times more likely to have a heart attack.
Which lupus patients are at risk for atherosclerosis?
Atherosclerosis can develop even when other lupus activity is quiet. The same risk factors that contribute to heart disease in the general population can also increase risk for lupus patients. These include high cholesterol, high blood pressure, diabetes, smoking, lack of exercise, and increased age (Note: even though the risk compared to healthy age-matched people is highest in young patients, the heart attacks and strokes still occur most commonly in older patients). However, these traditional risk factors for heart disease still don’t completely account for the increased risk we see in lupus patients. This suggests that inflammation from lupus itself may be a contributing factor.
Can I tell if I am at risk for atherosclerosis?
Many research groups (including ours at UCLA) are working to identify quick and easy tests (called biomarkers) that will help doctors identify which patients are at highest risk. In the future, this will hopefully allow doctors to treat patients early and prevent heart attacks and strokes from happening.
What can I do now to prevent heart attacks and strokes?
There have not been any studies to date that tell us exactly how to prevent atherosclerosis and its complications in patients with lupus. For now, the best approach is to minimize any known risk factors. This includes getting good control of high blood pressure, high cholesterol, and diabetes. Although exercise is sometimes difficult for lupus patients, any regular exercise (even walking) is helpful. Eating a “heart healthy” diet that is low in saturated fats and high in fruits and vegetables is helpful. And last but not least, quitting smoking is one of the biggest steps you can take towards being “heart healthy.”
If you have any symptoms of chest pain or shortness of breath, call your doctor right away!
By Maureen McMahon, MD