Caring for Your Cardiovascular System

Heart Disease

Heart disease is present in one of every three 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 heart 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.

How does lupus make the heart sick?
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.)

What about coronary artery disease?
More than 1 in 3 people with lupus have this problem, 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.

Is it necessary to see a heart specialist?
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.

Are there people with lupus at extra risk for heart problems?
Certain populations, such as black women, need to be particularly watchful for heart problems. Not only is heart disease the number one killer of all black women, but the death rate from heart disease is much higher in women of color. Black women are also three times more likely than white women to have lupus—which in itself raises the risk for heart damage.

Are doctors learning more about lupus and heart disease?
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: Michael D. Lockshin, M.D.


Lupus and the Heart

By Michael Lockshin, MD
Hospital for Special Surgery, New York, NY

How serious a threat does lupus pose to heart health?
The cardiovascular system is a main target of lupus. It can directly weaken the heart by causing inflammation of the muscle itself (myocarditis) or its inner lining (endocarditis). But the most common heart involvement in people with lupus is inflammation in the sac around the heart (pericarditis), which causes shortness of breath and sharp chest pain. These complications are typically treated with powerful anti-inflammatory and immune system suppressants such as prednisone, a corticosteroid.

What about coronary artery disease?
More than a third of people with lupus are at risk for this complication, primarily because inflammation and various immune system abnormalities cause the coronary arteries to rapidly harden, narrow, and clog, a condition called atherosclerosis. In time, clots can form or bits of plaque can break off from artery linings, interfering with blood flow to the heart and brain. Less common causes of coronary artery problems in people with lupus include inflammation of the artery walls, actual spasms of the arteries, and blood clots. The potential for problems forms a chilling picture, with women lupus patients 50 times more likely than their peers to have chest pain or a heart attack. (Less is known about the increased risk among the 1 in 10 men with lupus.)

But I'm still young, and I take pretty good care of myself.
It appears that having lupus by itself means a person is more likely to develop coronary artery disease. Young women with lupus (under age 40) are nearly five times more likely to have this ailment than their same-age peers—regardless of whether they have other risk factors such as smoking, high blood pressure, diabetes, or excess weight. Over time, lessened blood and oxygen flow to the heart weaken the muscle. Bits of cholesterol can break off from artery linings, interfering with blood flow to the brain as well as the heart. Long-term use of corticosteroids can also cause harm.

What can I do to keep my heart healthy?
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 the doctor, including heart specialists (cardiologists). Some doctors put lupus patients with coronary artery disease on cholesterol-lowering drugs called statins.

Are certain people with lupus at particularly high risk for heart problems?
Certain populations, such as black women, need to be particularly vigilant. Not only is heart disease the number one killer of all black women, but the death rate from heart disease is nearly 70 percent higher in women of color than it is in white women. Black women are also three times more likely than white women to have lupus—which in itself raises the risk for heart damage.

What are the primary areas of research in lupus—and is the cardiovascular system one of them?
With no major new treatment approved in more than 40 years, lupus needs a breakthrough. Researchers have made significant headway recently, however, reporting exciting findings in terms of how the disease works and what can be done to treat it. Among the discoveries are a deeper understanding of the genetic links to lupus and enhanced recognition of how lupus attacks the brain, kidneys, and skin. And several promising advances have also been made in figuring out lupus heart disease. Researchers have learned a lot more about immune system abnormalities that target this organ and have greater insight into biomarkers (predictors) of atherosclerosis. There are also improved techniques for early detection of heart disease, and more options for drug treatment.

Are companies developing new drugs to treat lupus?
Yes, finally. Several pharmaceutical companies are developing new medications. An online search will generate information on these companies and their drugs. You also can find websites that report new drug findings, such as www.LupusNY.org and www.LupusResearchInstitute.org.

How can I help advance research and drug development?
As a person with lupus, you can directly help in advancing lupus science—and simultaneously help yourself—by participating in a clinical trial. A clinical trial is a research project that evaluates the safety and effectiveness of medical treatments, drugs, or devices in human beings. The Food and Drug Administration (FDA) requires that such trials be performed before a product can be prescribed to patients. For information on clinical trials in lupus, try visiting the following websites: www.clinicaltrials.gov; www.LupusNY.com; www.centerwatch.com.

What is the outlook for people with lupus?
There isn't a cure yet, but every year now researchers are gaining promising new insights into this disease and uncovering promising treatments. Just twenty years ago, only 40 percent of people with lupus were expected to live more than three years following a lupus diagnosis. Now, with earlier diagnosis, refinements in treatments, and careful monitoring, most people with lupus can look forward to a normal lifespan. More than 80 percent of people diagnosed with lupus in 2005 will live for 10 years or more.