There’s a common misperception that the major cause of death in people with lupus is the disease itself. Not so. Actually, it’s coronary artery disease, the most common form of heart disease.
Heart disease is the number one cause of death in this country, according to the Centers for Disease Control and Prevention. There is a difference by gender, though. The disease is more common in men under the age of 55. Premenopausal women are usually protected. Over the age of 55, however, the risks in both genders are similar.
Dr. Brittany Weber, cardio-rheumatologist with the Lupus Program at Brigham and Women’s Hospital. PHOTO: Courtesy of Brittany Weber, M.D.
Young women with lupus, however, are not afforded that protection. “Heart disease is about three times higher in lupus, particularly in the young,” explained Dr. Brittany Weber, a cardio-rheumatologist with the Lupus Program at Brigham and Women’s Hospital. “Studies show that young people with lupus have increased plaque in their arteries compared to those without lupus,” she continued.
The plaque found in lupus, however, is typically not caused only by the risk factors cited by the Framingham Study — age, high blood pressure, smoking, obesity, high cholesterol. Inflammation is the culprit here. Inflammation damages the inside of blood vessels, resulting in the buildup of plaque, which can lead to heart attacks and strokes.
Another factor increases the risk of coronary artery disease in some people with lupus. A syndrome called APS (antiphospholipid syndrome) causes blood clots that can obstruct the flow of blood in the arteries that increase the risk of a heart attack and stroke.
Actually, no part of the cardiovascular system is spared. Lupus attacks not only the blood vessels, but also the heart valves and the heart muscle itself. A fairly common affliction is pericarditis, or inflammation of the sac lining of the heart. Pericarditis is characterized by sharp pain and rapid heartbeat.
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Treatment
Ironically, some medications used to treat lupus may add to the problem. Recent research published in the National Institute for Health and Care Research found that the risk of cardiovascular disease increases with the dose and duration of steroid treatment. Steroids can cause high blood pressure, diabetes and high cholesterol, all of which can lead to heart disease. Because of this, there is a push to keep steroid doses as low as possible and use “steroid-sparing” medications instead.
Disparity
People of color with lupus are hard hit. “Blacks and Hispanics have an elevated risk of stroke,” explained Weber. Studies published by rheumatologists at Brigham and Women’s Hospital found that Black patients with lupus in this country covered under Medicaid are at a 34% higher risk of stroke than white patients, while Hispanics had a 25% greater risk.
The bottom line
The good news is that if lupus is controlled and treated early, the risk of cardiovascular disease decreases, explained Weber. “Living with Lupus” by the Lupus Program at Brigham and Women’s Hospital offers tips to decrease the chance of developing heart disease. Stop smoking; aim for 30 minutes of exercise a day; stock up on fruits and veggies; control your blood pressure, weight and cholesterol. Manage your stress.
“If lupus is controlled, it is easier to manage heart disease,” says Weber.
