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Cardiovascular Complications and Lupus

Reviewed by: HU Medical Review Board | Last reviewed: January 2020

Cardiovascular disease is the leading cause of death in people with lupus rather than lupus itself. Cardiovascular refers to the heart (cardio) and blood vessels (vascular). The body’s blood vessels seem to be particularly vulnerable to the inflammation of lupus, but the heart and pericardium (sac around the heart) also can be damaged.

In fact, 50 percent of people with lupus experience high blood pressure, chest pain, atherosclerosis (hardening of the arteries), pericarditis (inflammation of the heart sac), myocarditis (inflammation of the heart muscle), Raynaud's phenomenon, blood clots, and other complications related to the heart and blood vessels.1,2 One study found that fatal heart attacks are 3 times more common in people with lupus compared to the general population of the same age and gender.3

Angina, vasculitis (inflammation of the blood vessels), endocarditis (inflammation of the heart valves), atrial fibrillation, and purplish skin discoloration (livedo reticularis) may also occur.1,2,4

Atherosclerosis and lupus

Atherosclerosis, which is commonly known as hardening of the arteries, is the most common cardiovascular complication of lupus. It occurs when cholesterol (a type of fat) collects along the inner lining of the arteries, making them smaller and less flexible. This makes it harder for blood to flow throughout the body which can lead to a heart attack. If the hardened fat, called plaque, breaks off it can cause a blood clot to form which can lead to stroke, pulmonary embolism, or deep vein thrombosis.1

Scientists do not fully understand why lupus leads to atherosclerosis. Most believe that the combination of C-reactive protein, antigens, antiphospholipid antibodies commonly found in the blood work of people with lupus inflames and damages the lining of the blood vessels.4

Heart disease and lupus

Lupus contributes to heart disease in a variety of ways. Lupus nephritis leads to high blood pressure that damages the heart and blood vessels. The steroids used to control lupus symptoms are known to damage the heart with long-term use. Then, the elevated levels of antiphospholipid antibodies, cytokines, and antigens generated by lupus cause inflammation that damages the heart.

People may also have traditional risk factors for heart disease separate from lupus, such as a family history of heart disease, obesity, metabolic syndrome, diabetes, lack of exercise, and smoking.4

Metabolic syndrome and lupus

Metabolic syndrome, a cluster of health conditions that can lead to type II diabetes, is common in people with lupus. Metabolic syndrome includes obesity, high cholesterol, high blood pressure, and elevated blood sugar levels. Doctors believe metabolic syndrome in people with lupus is caused by a combination of the disease itself, steroid use, and lifestyle issues, such as lack of exercise.4

Cardiovascular disease symptoms

Cardiovascular disease usually develops over time so it is important to pay attention to the early signs that you may have a problem. Common symptoms include:

  • Chest pain
  • Fatigue or weakness
  • Shortness of breath
  • Changes in skin color
  • Coughing or wheezing
  • Fainting, dizziness, or lightheadedness
  • Swelling in the legs, ankles, or feet
  • Pain or numbness in the muscles of the feet, calves, or thighs
  • Fast or uneven heartbeat (palpitations)
  • Difficulty speaking or moving limbs on one side of the body

Many of the symptoms of cardiovascular disease may overlap with the regular symptoms of lupus, so you should talk with your health care team if any of these signs get worse or appear suddenly.5

Cardiovascular complications treatments

There are many options to treat cardiovascular disease. What your doctor recommends will depend on your symptoms. Common treatments include:4

  • High blood pressure medicines to control blood pressure
  • Anticoagulants to break up blood clots
  • NSAIDs to reduce inflammation
  • Steroids to reduce inflammation
  • Antibiotics to fight infections

Because smoking and obesity (body mass index of >30) increases the risk of heart attack and stroke, your doctor will recommend many lifestyle changes to help control or slow your heart disease. Common recommendations include:4

  • Losing weight
  • Exercise
  • Smoking cessation
  • Low salt, low cholesterol, high nutrition diet

Estimate your body mass index (BMI) with this BMI calculator from the National Heart, Lung, and Blood Institute.

Since smoking and being overweight also makes other lupus symptoms worse, these lifestyle changes can also improve issues such as joint pain, osteoporosis, and kidney disease.4

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