Lupus and the Heart

Systemic Lupus Erythematosus is an autoimmune disease in which the body can react to itself causing inflammation in blood vessels. Lupus can affect many systems in the body including the heart, lungs, kidneys, nervous system and skin.

Words used when talking about lupus and the heart:

  • Cardiovascular – Having to do with the heart (cardio) and blood vessels (vascular).

  • Endothelial cells– Cells that form the inside wall of a blood vessel.

  • Coronary Artery Disease – Coronary arteries supply blood to the heart muscle. A decrease in the blood supply to the heart is usually caused by atherosclerosis and is considered a disease.

  • Atherosclerosis – Narrowing and hardening of blood vessels caused by too much cholesterol or other fatty materials in the blood vessel. This build up forms blockages called plaques that decrease the flow of blood. A plaque can also break off and travel to another blood vessel in your heart, lungs, brain or leg.

  • Cholesterol – A fat-like substance (also called lipid) that comes from foods, such as meat, poultry, eggs, dairy products, fried foods and fats. There are two types of cholesterol:

    • HDL (high-density lipoprotein) is the good cholesterol. Good cholesterol can be increased by weight loss and exercise.
    • LDL (low-density lipoprotein) is the bad cholesterol that forms plaques.
  • Statin – A category of medicines used to lower cholesterol levels in the blood

  • Cardiologist – A doctor who specializes in the treatment of heart problems

  • Pleurisy – Inflammation of the covering around the lungs

  • Pericarditis – Inflammation of the covering around the heart

  • Costochondritis – Inflammation of the cartilage of the chest wall

How common is heart disease in the United States?

Heart disease is the #1 cause of death in Americans. In general, heart disease is more common in men than in women before the age of 55. Premenopausal women (women still having a period before menopause) have lower risks of heart disease. Over the age of 55, men and women have equal risks of heart disease. Heart disease is more common in black women than in white women and it often is a more serious problem. Heart disease is the #1 cause of death in women of color.

Are people with lupus at greater risk for heart disease?

Yes, if you have lupus you have a greater risk of having heart disease. Studies show that the endothelial on the inside of blood vessels are damaged in lupus and repair is slow. This leads to plaques, atherosclerosis and coronary artery disease earlier than in people without lupus. Premenopausal women with lupus are NOT protected against heart disease as are other women. Young women with lupus have a much greater risk of having a heart attack than do young women without lupus.

How do my lupus medicines affect my heart?

Steroids, such as prednisone and medrol, can cause high blood pressure, high cholesterol, and diabetes mellitus, all of which increase the risk of heart disease. The higher the dose and the longer the time period, the higher the risk of heart disease becomes.

Can a flare of my lupus affect my heart?

Yes. Some people with lupus develop pericarditis (fluid around the heart) during a flare. The symptoms are sharp chest pain with breathing and a shortness of breath. The treatment is usually non-steroidal medications, such as ibuprofen and naproxen, or short courses of steroids, like prednisone. Rarely, individuals with lupus will have involvement of their heart muscles themselves. Lupus itself increases the risk of atherosclerosis and coronary artery disease.

Do I need to see a cardiologist?

Not every person with lupus needs to see a cardiologist, but in some cases it is a good idea. A cardiologist may order special tests to see how well the heart is working. Together with the rheumatologist, they decide if you need any medicines to prevent or treat heart disease. They may suggest that you take a statin to lower and maintain your cholesterol level. Rheumatologists and cardiologists agree that it is very important that you have good eating and exercise habits and that you control your blood pressure.

How can I decrease my chances of developing heart disease?

You should take an active part in controlling the following risk factors:

  • Stop smoking and encourage others to stop because their smoking affects the air you breathe.

  • Aim to get at least 30 minutes or more of exercise or continual activity such as walking seven days a week.

  • Read food labels and eat more fruits, vegetables and foods with less fat.

  • If you are having problems with your weight, talk to a nutrition counselor who can help you with a plan that will work for you. Lose weight slowly by combining your diet with activity.

  • Control your blood pressure.

  • Manage your stress.

  • Lupus patients should be followed closely for their lupus disease activity, as well as their cholesterol, blood pressure, and blood sugar, which increase the risk of heart disease if too high.

What else should I know?

  • Learn more about symptoms and treatments:

  • Know the warning signs of a heart attack and know what to do if you have these symptoms.

Read our easy-to-print PDF version of this fact sheet.

Please note: This information is intended to complement, not replace, the advice and care you receive from medical and health professionals.

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