Lupus can affect the cardiovascular system, which includes your heart and blood vessels. In fact, cardiovascular disease, not lupus itself, is the number one cause of death in people with SLE. Therefore, it is very important that you take steps to maintain optimal cardiovascular health. Do not smoke, since smoking increases the risk of cardiovascular disease. A low-fat, low-cholesterol diet is also essential. Focus on eating whole grains, vegetables, and lean sources of protein. Limit your sodium (i.e., salt) intake, since sodium levels are directly linked to blood pressure. In addition, try to exercise at least 30 minutes per day. This goal can be difficult for people with lupus who experience reoccurring joint and muscle pain, fatigue, and other symptoms. However, engaging in low-impact daily activities such as walking, biking, yoga, Tai chi, and other forms of stretching may help to alleviate some of this pain while also helping you to maintain a healthy weight and strong cardiovascular system.
Hypertension (High Blood Pressure)
Fifty percent of people with lupus experience hypertension (high blood pressure), which is defined as a blood pressure of greater than 140/90 mmHg. In addition, many more lupus patients have blood pressures greater than the normal 120/80 mmHg limit. The most common causes of high blood pressure in people with lupus are obesity, kidney disease, and long-term steroid use. Other medications, such as cyclosporine (Neoral, Sandimmune, Gengraf) can also cause elevations in blood pressure.
High blood pressure can lead to kidney failure, stroke, heart failure, and heart attack. Since cardiovascular disease is the number one cause of death in people with lupus, it is very important that your blood pressure is brought to the healthy 120/80 mmHg level and kept there.
While it is important that you take steps yourself to help achieve and maintain optimum cardiovascular health, diet and exercise alone may be insufficient in controlling your blood pressure. Therefore, your doctor may prescribe a medication that works to lower, control, and/or maintain your blood pressure. Each medication works in a different way, and your doctor will work with you to evaluate and prescribe the blood pressure medication that best suits your personal condition.
Atherosclerosis
Atherosclerosis is the most common manifestation of cardiovascular disease in people with lupus. The condition is caused by the accumulation of cholesterol and other substances (known collectively as plaque) along the inner linings of arteries. Eventually, this plaque can harden and restrict the flow of blood to various parts of the body, including the heart and brain; if it ruptures, it can cause a clot to form, leading to complications like heart attack and stroke. Research has shown that being overweight and having high blood pressure are the two most important predictors of heart disease in SLE. In fact, the risk of heart attack in women with lupus aged 35-44 is 50-times greater than that of women without lupus, and for everyone with lupus the risk is increased 7 to 9-fold. Even though lupus itself contributes to the development of atherosclerosis, traditional factors, such as smoking, obesity, and high blood pressure, can exacerbate the condition and must be controlled.
Pericarditis
Pericarditis is the most common heart problem associated with active lupus and occurs in about 25% of people with SLE. The condition occurs when the pericardium—the thin membrane surrounding your heart—becomes swollen and irritated, causing it to leak fluid around the heart. People with pericarditis may experience pressure pains that are worse lying down and better sitting up. Your doctor will work with you to decide the best course of treatment for pericarditis. Often, NSAIDs or steroids are effective in reducing the inflammation associated with this condition.
Endocarditis
Libman-Sacks endocarditis occurs in about 15% of people with lupus. The condition leads to the development of growths called vegetations on the surface of heart valves. Usually this form of endocarditis is associated with antiphospholipid antibodies, which are present in about 50% of people with SLE.
Endocarditis can lead to two major complications: infection and stroke. Vegetations are prime sites for bacterial growth, and an infected valve requires surgical replacement. Visits to the dentist offer opportunities for bacteria to sneak into the blood and land on a heart valve. Therefore, people with severe heart murmurs should speak to their doctor about taking an antibiotic before receiving dental work. In addition, pieces of a vegetation can break off and travel through the blood stream, potentially blocking blood flow to the brain and causing a stroke. If you have a heart vegetation, your doctor will prescribe an anticoagulant to reduce this risk.
Myocarditis
Myocarditis, inflammation of the myocardium or heart muscle, occurs in fewer than 10% of people with lupus. People with this condition often experience a rapid heartbeat and chest pain, and x-rays may show an enlarged heart. Myocarditis may weaken your heart’s ability to pump blood to the rest of your body. Therefore, it is a serious complication that must be closely monitored and treated with high dose steroids for several weeks or months.
Sources
- “Pericardium and Pericarditis.” American Heart Association. 30 June 2009. <http://www.americanheart.org/presenter.jhtml?identifier=4683>.
- Petri, Michelle. Cardiovascular Systemic Lupus Erythematosus. In: Lahita RG, ed. Systemic Lupus Erythematosus. New York: Churchill Livingstone; 2004:905-923.
- Wallace, Daniel J. The Lupus Book: A Guide for Patients and Their Families. 1st ed. New York: Oxford University Press, 1995. 90-98.
- “What is Atherosclerosis?” Nov. 2007. National Heart Lung and Blood Institute, Diseases and Conditions Index. 30 June 2009. <http://www.nhlbi.nih.gov/health/dci/Diseases/Atherosclerosis/Atherosclerosis_WhatIs.html>.
