Lupus and the Cardiovascular System

Lupus and the cardiovascular system are about as friendly as the Montagues and the Capulets.  In fact, the cardiovascular system, (which includes the heart and blood vessels) sadly, can be a huge target for lupus.  Believe it or not, cardiovascular disease is the number one cause of death in people with systemic lupus erythematosus.  

In this blog we will be breaking down how lupus inflammation can affect the heart and how these heart and cardiovascular conditions can be treated.  

Pericarditis

25% of people with active lupus experience pericarditis.  It is actually considered the most common heart problem associated with SLE.  This condition is caused when the pericardium (a thin membrane that surrounds the heart) becomes irritated and swollen.  The swelling and irritation can cause fluid to leak around the heart.  With this condition, side effects may include: pressure painsHEART ANATOMY cross section diagram in the chest when lying down, shortness of breath, low fever, and fatigue.  The treatment plan for pericarditis usually includes NSAIDS (non-steroidal anti-inflammatory drugs) or steroids to decrease the inflammation.  

Myocarditis

10% or less of people with lupus develop myocarditis.  Myocarditis is inflammation of the heart muscle (myocardium).  This issue can weaken the heart’s ability to pump blood to the rest of the body.  If you have this condition, you may experience a rapid (fast) heartbeat, chest pain, and tests may show an enlarged heart.  This is a serious condition that needs very close monitoring.  It is usually treated with heavy steroids for an extended period of time.  

Endocarditis

15% of people with lupus may develop Libman-Sacks endocarditis.  This form of endocarditis is associated with Antiphospholipid Syndrome antibodies.  This his condition causes growths on the surface of the heart valves and can lead to infection and a stroke.  It generally occurs when germs (bacteria) spread to your heart from other parts of your body through your bloodstream.  The bacteria or “growths” can damage or destroy your heart valves and lead to serious complications.  Treatments include antibiotics and sometimes, surgery.  

Hypertension

Hypertension is defined as a blood pressure that is greater than 140/90.  Normal blood pressure should be around 120/80.  Blood pressure can be more difficult to control in lupus patients because prednisone and other NSAIDS (non-steroidal anti-inflammatory drugs) can elevate it.  Kidney disease may also affect your blood pressure and can be one of the first symptoms people experience who have lupus nephritis.

High blood pressure simply means that you have a greater force of blood pushing against the walls of your arteries.  Sometimes this increased pressure can cause damage to the walls of the blood vessels, and can lead to other cardiovascular problems and hardening of the arteries.  Besides medications like diuretics, beta blockers, ACE Inhibitors, alpha blockers and angiotensin blockers there are other things you can do on your own to help either lower your blood pressure or not make matters worse.  They are:

  • Stop smoking
  • Stop drinking alcohol in excess
  • Eat low sodium foods
  • Eat fresh unprocessed foods
  • Exercise and maintain a healthy BMI

Atherosclerosis

Atherosclerosis, also knows as ASVD or premature coronary heart disease, is a form of arteriosclerosis where the artery wall thickens in result of a build up of white blood cells.  The build up of the cells causes a fibro fatty plaque that affects the elasticity of the artery walls.  It can cause hardening and narrowing of the arteries, and after time, slowly block the artery from obtaining proper blood flow.  It can cause strokes, heart attacks, and peripheral vascular disease.  Some studies have shown that people with lupus are more than 50 times more like to develop atherosclerosis than that of the general population.

The “good” and “bad” cholesterol link:  HDL cholesterol is often times referred to as the “good” cholesterol and LDL is considered the “bad.” However, in studies funded by the Alliance for Lupus Research, they have discovered that there are abnormal HDL (referred to as piHDL) levels that may exist in people with autoimmune disorders such as lupus.  This could be the catalyst for those with lupus developing atherosclerosis.  However, the presence of piHDL may help serve as a marker to identify those who have a higher risk of developing cardiovascular disease and, in turn, allowing those to take preventive actions if needed.   

Treatments include: high cholesterol and high blood pressure medications and lifestyle changes.  Doctors may also use angiography and stenting.  Sometimes bypass surgery is needed to help blood flow and oxygen pass properly to the heart. This is accomplished by a surgeon taking a blood vessel from another part of the body (leg, chest or arm) to go around the blocked artery.   This procedure is the most common type of heart surgery in the USA.  

Take Your Heart into Your Own Hands 

At the end of the day, maintaining a strong and healthy heart/cardiovascular system is imperative to preventing the above mentioned conditions.  Yes, lupus can make things more difficult, but it doesn’t mean that you should throw in the towel and not take other proactive measures to help your system out.  

 

Be mindful of:

  • Staying physically active (to the best of your ability) to help lower blood pressure and bad cholesterol levels.
  • Eat heart-healthy foods! Fresh foods that are high in omega’sMexican doctor listening to patient's heart
  • Reduce stress
  • Keep a healthy BMI (body mass index)
  • Avoid Tobacco
  • Limit alcohol intake
Sources:
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