Learn About Lupus and the Heart

From the 2012 Lupus Education Series

A significant complication for many people with lupus, heart disease, was the focus of a presentation by Dr. Maryann Lee at Staten Island University Hospital. What stood out most was Dr. Lee’s explanation of two different types of heart disease affecting people with lupus and what can be done to help minimize risks.

Maryann Lee, MD

Dr. Lee discussed the different types of heart disease: Coronary and Non-coronary heart disease.

Coronary heart disease (CHD) refers to the build-up of plaque that narrow the heart’s arteries, limiting the flow of blood back to the heart. It is often referred to as atherosclerosis or hardening of the arteries. Non-coronary disease refers to other processes that can lead to heart disease not associated with coronary disease.

Non-coronary heart disease includes:

Valvular disease

Damage to one of the heart valves, often caused by bacteria. Once damaged, the valve is more likely to become infected. Pieces of the valve can break off and can lead to stroke. Patients with valve damage should be on antibiotics to prevent an infection for certain types of surgery that might introduce bacteria to the body. Steroids and other immunosuppressives don’t seem to be effective.

Pericardial disease

  • Pericarditis – The lining of the heart is inflamed but usually does not cause any obvious symptoms.

  • Pericardial effusion – When there is too much fluid around the heart. It occurs in about half of lupus patients, and usually can be treated with non-steroidal inflammatory drugs (NSAIDS) and steroids.

  • Myocarditis – Inflammation to the heart muscle caused by infections, viruses, or immune diseases such as lupus. This occurs rarely but needs to be treated aggressively when it does occur.

  • Conduction defects – When the electrical system of the heart is disrupted and can lead to arrhythmias such as heart block. It is usually short term and reverses with time.

Coronary Heart Disease

Women with lupus in their 30s and 40s are twice as likely to develop heart disease as women without lupus.

Women with lupus have an increased risk of atherosclerosis leading to heart attack.
Coronary heart disease is one of the leading causes of morbidity and premature death for people with lupus.

Traditional risk factors and factors particular to lupus play a role in developing heart disease. 

Managing the Risk for Heart Disease

Traditional risk factors for heart disease are important for people with lupus. Modifiable risk factors like diabetes, high cholesterol, hypertension, family history, obesity, and non-active lifestyle should be addressed.

There are some things we can’t control but it’s important to control as many lifestyle choices as possible to cut down your risk for heart disease. These include:

  • exercising
  • controlling weight
  • eating a healthy well-balanced diet
  • keeping cholesterol at a healthy level.

While these are generally healthy recommendations, you should always check with your doctor before making any major changes to your medications, diet, or exercise routine.

 

Maryann Lee, MD
Dr. Maryann Lee practices rheumatology at the University Physicians Group on Staten Island, which is affiliated with North Shore-LIJ/Staten Island University Hospital.  She is also on staff at Staten Island University Hospital where she supervises the arthritis clinic. She attended the University of Medicine and Dentistry of New Jersey Medical School and completed her rheumatology fellowship at Albert Einstein College of Medicine and Montefiore Medical Center. 

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