Heart Disease Is A Major Complication Of Lupus - February Is National Heart Month

Main Category: Lupus
Also Included In: Heart Disease
Article Date: 04 Feb 2008 - 2:00 PST

email to a friend   printer friendly   opinions  

Heart disease is a major complication of lupus and is now a leading cause of death among people living with autoimmune disease. Individuals with lupus are at increased risk for cardiovascular disease (CVD), which involves hardening of the arteries and can lead to heart attacks or strokes later in life. As the nation observes February as "National Heart Month," the Lupus Foundation of America is calling attention to this serious complication of lupus, an autoimmune disease that affects an estimated 1.5 million Americans.

Lupus is a chronic (lifelong) disease in which the immune system fails to tell the difference between foreign invaders, such as viruses and bacteria, and the body's own cells. The immune system then produces auto-antibodies ("auto" means "self") which mistakenly attack healthy tissue. These auto-antibodies cause inflammation, pain and damage to various parts of the body, including the heart, lungs, kidneys and brain.

Several studies have provided evidence that inflammation plays a role in heart disease. Inflammation causes a build-up of fatty deposits called plaque within coronary arteries, blood clots, and blockage of blood vessels within the heart - placing one at increased risk for heart attack.

As the outlook for people with lupus has improved significantly over the past few decades, heart disease and other cardiac problems have surfaced as the most serious long-term risk for people suffering from lupus. Several decades ago, when lupus patients died shortly after developing lupus, the cause of death was often attributed to undiagnosed and untreated lupus. However, when patients lived for years after their diagnosis, the main cause of death changed to atherosclerosis, which occurs when cholesterol and other fatty deposits block the passageways where blood flows to the heart.

In studies that compared a group of women with lupus to a group of healthy women, researchers found that the lupus patients were more likely to have traditional risk factors for heart disease, such as diabetes and hypertension. In addition, these women had an earlier onset of menopause, and had higher levels of unsafe blood fats, including triglycerides and low-density lipoprotein (LDL) cholesterol. These factors are all exacerbated by the inflammation caused by lupus and contribute to the increased risk of coronary heart disease and accelerated atherosclerosis.

However, these factors alone do not fully account for the increased risk. Several factors more specifically related to lupus are proposed to have considerable importance, including chronic inflammation, antibodies that attack proteins that regulate the blood vessels, and therapy, especially corticosteroid use. As a result, researchers suggest that lupus should be considered equivalent to coronary heart disease as a known risk for heart attacks and strokes.

Because concerns about coronary heart disease in lupus patients have increased dramatically, researchers are studying potential therapies to reduce these risks. These include developing treatments that incorporate cholesterol-lowering drugs and aspirin-therapy. Meanwhile, lupus patients can take well-known steps to help lower their risk: lose weight, stop smoking, lower blood pressure, and get moderate aerobic exercise.

How Lupus Affects the Heart

Pericarditis

The most common way that lupus affects the heart is through inflammation of the pericardium, the sac that surrounds your heart. The symptoms of pericarditis that you may experience are sharp pain in your chest and, occasionally, shortness of breath. Pericar-ditis usually does not damage your heart's ability to function because it does not directly involve the heart tissue. However, inflammation that is chronic (long-lasting) can scar the heart tissue, which can interfere with the heart's ability to pump blood.

Myocarditis

Lupus can cause inflammation of the myocardium, the muscle tissue of your heart. The symptoms are chest pain and an unexplained rapid or irregular heart beat. Myocarditis is often seen when there is inflammation in other muscles in the body.

However, myocarditis can be caused by viral, bacterial, and fungal infections. Because lupus itself creates an added risk for developing infections-especially if you are taking certain immunosuppressive drugs-you are at increased risk for this type of myocarditis.

Though serious heart muscle disease is not commonly caused by lupus, heart failure can occur if your heart does not have the strength to pump enough blood to the different tissues and organs.

Endocarditis

The endocardium is the tissue that lines the inner walls of your heart and the valves that separate the heart's different chambers. Lupus can cause inflammation of the endocardium. Lupus endocarditis usually causes the surfaces of the heart valve to thicken or develop wart-like growths (lesions). These lesions can become infected, a condition called bacterial endocarditis. A lesion also could break off and travel to the brain to form a blood clot. Both of these possibilities are potentially very dangerous.

Coronary Artery Disease

The coronary arteries move blood to and from your heart. Over time, fatty molecules and other materials may attach to the walls of these blood vessels and form plaque, which makes the blood vessels narrower and restricts blood flow. This condition is known as atherosclerosis. A decrease in blood flow can cause angina (chest pain). However, if the blood flow to your heart is interrupted-either by plaque or by a blood clot that develops when plaque breaks off-you could be at risk for a heart attack.

When you have lupus you are at increased risk for coronary artery disease. This is partly because people with lupus have more risk factors, which may include:

- hypertension from kidney disease or corticosteroid use
- elevated cholesterol levels from corticosteroid use
- type 2 diabetes from corticosteroid use
- an inactive, sedentary lifestyle due to fatigue, joint problems, and/or muscle pain

However, even after taking these risk factors into account, people with lupus are more likely to develop atherosclerosis. You can help reduce your chances of heart attacks and other complications from coronary artery disease in several ways:

- control the risk factors
- control the lupus disease activity
- talk to your doctor about reducing or stopping your corticosteroid use

Additional Information

LFA sponsored research on Lupus and Heart Disease
Cardiopulmonary Disease and Lupus

Lupus Foundation of America

• Additional
• References
• Citations