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How Lupus Affects The Heart


Introduction

Lupus is a life-altering and potentially fatal disease that causes the immune system to attack healthy cells by mistake, causing inflammation and tissue damage. Though not a "woman's disease" it disproportionately affects women, between the ages of 15 and 44. And of those, two-thirds are women of color. The cause of lupus is still unknown and there is no cure.


The inflammation that lupus causes can happen anywhere - however, it most commonly affects the joints, skin, kidneys, lungs, brain, and the heart, causing swelling and pain that can dramatically affect a person's quality of life.


This blog will specifically target how lupus may affect the heart, how it is treated, and what you can do to be proactive with your cardiovascular health if you have lupus.


The Cardiovascular System:

Your heart, and the blood vessels, arteries, veins, and capillaries that carry blood to the rest of your body are referred to as your “cardiovascular system.” Throw your lungs into the equation and you’ve got yourself quite the complex network of pathways of blood circulating and transporting oxygen and important elements to various parts of your body. This process is needed for your cells and other systems in your body to function properly.


If your cardiovascular system is compromised either from illness, injury, or genetic variants, you will most likely be referred to a cardiologist for treatment. In fact, about 50% of lupus patients experience heart complications as a result of their disease.


The Hard “Heart” Truth:

Cardiovascular disease is the number one cause of death with SLE. It is a major complication with this disease and should not be ignored. Pre-existing medical conditions like diabetes, high-blood pressure, and obesity can increase the risk of cardiac episodes and poor health outcomes in lupus as well.


Another potential risk for lupus patients developing cardiovascular disease is the lupus overlap condition called Antiphospholipid Syndrome. Between 30-40% of lupus patients develop antibodies (aPL) that target their own blood vessels and clotting proteins, leading to blood clots in various organs in the body. Lupus patients who also have these antibodies have a higher risk of valve disease, pulmonary hypertension, blood clots, miscarriage, and organ damage.


Conditions of the Heart:

  • Pericarditis: Probably the most common condition associated with lupus and the heart is when the lining of the sac around your heart (pericardium) becomes inflamed. Symptoms include sharp chest pains, shortness of breath, and fatigue. Thankfully, pericarditis typically does not interfere with the function of the heart because it doesn’t affect the inner heart tissue; however, if the pericardium is chronically swollen, you can develop scar tissue which may interfere with the hearts ability to effectively circulate blood.


  • Myocarditis: The muscle of your heart is called your “myocardium.” Lupus can cause inflammation in this area, particularly in patients who are prone to muscle swelling. The symptoms include chest pain, and rapid or irregular heart beat. Other things can cause the development of myocarditis, like bacterial, viral, and fungal infections. If you are on immunosuppressive medications, you are at an increased risk to develop myocarditis; however, only 10-15% of patients develop symptomatic myocarditis.


  • Endocarditis: The tissue that lines the inner heart wall and the valves that separate the heart's chambers is called the endocardium. When lupus affects that part of the heart, the swelling is called “endocarditis.” This disease can cause lesions and thickening of the heart valves. It can even cause infections which can lead to blood clots. The development of endocarditis can be very dangerous. Though uncommon in people with healthy hearts, Libman- Sacks endocarditis has been seen in association with SLE and antiphospholipid syndrome and studies have shown that it is present in over 6% of lupus patients.


  • Coronary Artery Disease: Coronary artery disease develops when the major blood vessels that supply your heart become damaged or diseased. The risk that a lupus patient will develop coronary heart disease is significantly higher than that of the general population. In fact, women between the ages of 35 to 44 years with SLE are more than 50 times more likely to have a heart attack than women of similar age who don’t have lupus. Why is this? Doctors believe it is due to inflammation levels, not traditional risk factors like age, gender, tobacco use or high blood pressure and cholesterol levels. Steroid use and renal disease may also contribute to the development of CAD.


  • Accelerated Atherosclerosis: Similar to CAD, the increased risk for development of atherosclerosis is not fully explained by traditional risk factors. This condition triggers a decrease in blood flow that causes chest pain (angina) from plaque attaching to the walls of blood vessels. If blood flow to your heart is interrupted, you can be at serious risk for a heart attack.


  • Vasculitis: Vasculitis is caused by inflammation of the blood vessel walls. The symptoms of lupus-induced vasculitis can vary depending upon which tissue areas are involved, but may include: fever, poor appetite, weight loss, headache, blurry vision, seizures, and strokes.


Treatments and Preventative Measures:

When you have lupus, it is essential to be proactive with maintaining good cardiovascular health.


If you:

  1. Have kidney disease from lupus and suffer from hypertension,

  2. Have elevated cholesterol levels,

  3. Have type 2 diabetes from corticosteroid use,

  4. Or are inactive, or sedentary because of joint/muscle pain or fatigue...



It is IMPORTANT to talk to your doctor about reducing your chances of developing atherosclerosis, suffering from a heart attack, or developing another cardiovascular issue. It is imperative to speak with a cardiologist and your rheumatologist about controlling your lupus disease activity, tapering off corticosteroids if necessary, and controlling other risk factors.


Thankfully, most conditions involving the heart with lupus can be treated with nonsteroidal anti-inflammatory drugs (NSAIDS) or with a short dose of corticosteroids. If you live with moderate to severe disease activity, other immunosuppressive and/or immunomodulatory drugs can be used. These include:

  • Azathioprine

  • mycophenolate mofetil

  • Belimumab

  • Cyclophosphamide

  • Intravenous immunoglobulin (IVIG)


In rare instances where symptoms of swelling in the heart are severe, it may be necessary to remove the excess fluid by inserting a needle into the chest. In case of heart failure, medications like beta-blockers or angiotensin converting enzyme (ACE) inhibitors are recommended. In case of coronary artery disease, blood thinners (such as warfarin, aspirin) are used to prevent forming of blood clots in the damaged/inflamed coronary arteries. Systemic corticosteroids may be necessary to control the inflammation in the coronary arteries. Rhythm abnormalities can be treated with antiarrhythmic drugs, although in severe cases, invasive procedures such as implant of a pacemaker may be necessary.



Conclusion:

We know it can be scary to read what may happen to your heart if you have active lupus and APL. However, various lifestyle modifications and controlling lupus disease activity are very helpful in reducing your risks of cardiovascular disease.


Consider these suggestions:

  • Maintaining healthy diet habits with low intake of saturated fats and cholesterol

  • Maintaining ideal weight

  • Quitting smoking

  • Decreased alcohol consumption

  • Control of blood glucose levels to avoid diabetes

  • Maintaining a normal blood pressure.

Written By:

Kelli Roseta


**All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog is owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2020.



Sources:

https://www.hss.edu/conditions_top-ten-series-lupus-heart-conditions.asp

https://www.lupus.org/resources/how-lupus-affects-the-heart-and-circulation

https://rarediseases.info.nih.gov/diseases/5824/antiphospholipid-syndrome#:~:text=Antiphospholipid%20syndrome%20(APS)%20is%20an,makes%20antibodies%20that%20attack%20phospholipids.

https://www.ncbi.nlm.nih.gov/books/NBK532864/


February 2021