LUPUS and the heart

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LUPUS and

the heart

Lupus can speed the

processes that cause heart and blood vessel disease, increasing the likelihood

of heart attack and stroke. Medical treatment and lifestyle changes can help

reduce the risk.

Systemic lupus erythematosus,

like rheumatoid arthritis, is an autoimmune disorder, in which the body’s

immune defenses turn against the body’s own tissues. The attack often

leads to swollen, painful joints, but many organs can become targets in people

with lupus. Increasingly, researchers are discovering that lupus takes a toll

on the cardiovascular system. It’s not unusual for 30-year-olds with

lupus to have blood vessels resembling those of people twice their

age—putting them at significantly higher risk for heart attack or stroke.

The vessel-lupus saga

Scientists are still working out all the ways

lupus contributes to cardiovascular disease. One factor that’s clearly

involved is a premature or accelerated form of atherosclerosis—the

destructive process in which artery walls become lined with fatty deposits,

often obstructing blood flow. One research team recently found that in young

women with lupus, the protective cells lining blood vessels die sooner and are

more slowly replaced than those in healthy women the same age. These vessels

may be more vulnerable to damage and cholesterol buildup.

The inflammation that accompanies lupus almost

certainly has a role. Inflammation is now recognized as a major contributor to

heart and blood vessel disease in otherwise healthy people. Thus, it stands to

reason that inflammation is at least partly to blame when cardiovascular

disease occurs in people with lupus.

Another contributor to the risk of

cardiovascular disease may be medications sometimes used to treat lupus. Some

evidence points to corticosteroids, such as prednisone, which are often

prescribed to reduce lupus-related inflammation. These medications may promote

atherosclerosis either directly or by triggering other conditions such as high

blood pressure.

The current consensus is that an interplay of these factors causes many people with lupus

to develop cardiovascular disease well before their time. And there’s

little debate over the scope and seriousness of the problem: Up to 15% of

people with lupus have angina (cardiac chest pain), a history of heart attack,

or other symptoms of coronary artery disease; as many as 8% have suffered

strokes. Indeed, cardiovascular disease is the third most common cause of death

among people with lupus.

Reducing the risk

The good news is that thanks to recent

improvements in diagnosis and treatment, people with lupus can expect to live

longer, healthier lives. Your physician may take a number of steps to minimize

cardiovascular complications. Depending on your level of risk, you may have one

or more imaging tests ordered. Computed tomography (CT) or ultrasound scanning,

for example, may be done to see whether the disease has affected your blood

vessels. If you need to take a corticosteroid, the doctor will carefully gauge the

dose to minimize its cardiovascular impact. In some cases, you may also be

given another drug, Plaquenil (hydroxychloroquine).

It not only helps lupus but has a positive effect on blood fat levels and the

tendency to form blood clots. If your doctor decides that you are at high risk

for cardiovascular disease or discovers that you already have it, you may be

asked to take low doses of aspirin and, in some cases, a statin

drug. Both medications help to slow atherosclerosis and prevent heart attack

and stroke.

At-home measures

Most people with lupus have at least three

traditional cardiac risk factors, such as high blood pressure, abnormal blood

fat levels, obesity, inactivity, and diabetes. If you’re among that

majority, your doctor will detail a program for you to follow that will bring

your risk factors under control. Many people need to eat a healthier diet and

get more exercise. Medications may be necessary to lower your blood pressure,

blood cholesterol, or blood sugar levels. If you smoke, obviously you should

try to stop. Alcohol should be consumed only in moderation.

From Archives of Internal

Medicine and University of Michigan Health System

Published: May/Jun 2004