Apr. 01, 2014

Have a Heart

February was Heart Disease Awareness Month, so we asked cardiologist Shilpa Kshatriya, M.D., FACC, who sees people with lupus at her clinic in Wichita, Kan., to provide an overview of what you need to know about lupus and cardiovascular disease (CVD).

Q: How does lupus affect the heart?
A: Lupus can cause blockages in heart arteries (coronary artery disease, or CAD), leakage of heart valves, irritation of the outer layer of the heart, and even heart failure.

Q: How common is heart disease in lupus?
A: A 2013 review of data on cardiovascular disease and lupus (Seminars in Arthritis and Rheumatism 2013) finds “at least 2- to 3-fold elevated risks of myocardial infarction, congestive heart failure, cerebrovascular disease, and overall CVD mortality” among individuals with lupus compared with the general population.

Q: At what age are women with lupus typically affected by CAD?
A: Ages 48-49 are most commonly affected by heart disease—almost a decade earlier than women without lupus.

Q: What are the risk factors for CVD in those with lupus?
A: Traditional risk factors are high cholesterol, high blood pressure, obesity, smoking, sedentary lifestyle, and diabetes. Lupus-specific risk factors for heart disease are older age at diagnosis, longer disease duration, and longer periods of steroid use. More active lupus, a history of kidney disease, the use of non-steroidal anti-inflammatory drugs (NSAIDs), and long-term use of cortico­steroids also increase CAD risk.

Q: Why does lupus increase the risk for heart disease?
A: The overall frequency of risk factors is higher in those with lupus, and the inflammation caused by lupus can affect the entire cardiovascular system. Also, women with lupus reach menopause on average four years earlier than women who do not have the disease, which is significant because they lose the cardioprotective effects of estrogen after that time.

Q: How can I minimize my risk for heart disease?
A: Diet, regular exercise, and blood pressure and cholesterol control all help reduce the risk. For those with diabetes, it’s important to closely monitor blood sugar. Also, consider talking to your doctor about starting an aspirin regimen or taking hydroxychloroquine (Plaquenil®), which has been shown to be cardioprotective by lowering total cholesterol and blood glucose levels. Finally, because smoking causes a threefold higher risk of a heart attack when you have lupus, consider quitting.

Learn more


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