Metabolic syndrome is marked by increased risk of cardiovascular diseases, so its incidence among people with lupus can indicate risk of cardiovascular disease in lupus patients.
New Review Summarizes the Risk of Heart Disease and Stroke Among People with Lupus
Heart disease and stroke are typically associated with risk factors like advancing age, smoking, gender and high blood pressure. However, these factors do not fully explain the increased risk of heart disease and stroke for people with lupus. In fact, research has shown that having lupus, and undergoing treatment can, in itself, be a substantial risk factor for heart disease and stroke.
Karen Costenbader, MD, MPH is an associate professor of medicine at Harvard Medical School, and a rheumatologist who co-directs the Lupus Center at the Brigham and Women’s Hospital in Boston, Massachusetts. To better understand the association between heart disease, stroke and lupus, Dr. Costenbader and her colleagues set out to address two questions:
1) What is the risk of heart disease and stroke among people with lupus, compared to those who do not have the disease?
2) What factors can increase the risk of heart disease and stroke for people with lupus?
To address these questions, the researchers reviewed and summarized 28 different studies on the subject. The overall results showed strong evidence that people with lupus had at least a two to three fold risk of heart disease and stroke, compared to those without lupus. Among individuals under age 45, those with lupus had a significantly higher risk of these events than their counterparts without lupus.
People with lupus also exhibited a higher risk of heart attack and stroke if they had certain risk factors, like smoking, increased age, high blood pressure and high cholesterol. In addition, several of the risk factors identified were lupus specific. The researchers’ analysis suggests that lupus patients are at increased risk having longer duration of the disease, increased disease activity and while taking certain medications, such as prednisone and other glucocorticoids. However, the risks of not taking needed immune-suppressing treatment should be carefully weighed against the possible risks of taking it.
For individuals with lupus, as well as their families and caregivers, this analysis underscores the importance of prevention. Engaging in regular exercise, not smoking, eating a healthy diet and controlling cholesterol levels and blood pressure are all ways to decrease the risk of heart disease and stroke. Additionally, individuals with lupus and their caregivers should advocate for doctors’ visits that include aggressive screening and management of risk factors for heart disease and stroke. In some cases, individuals may consider asking their rheumatologist for a referral to a preventive cardiologist, a health care professional that is focused on the prevention of future heart disease and stroke. Please visit the Lupus Foundation of America’s website to learn more about how lupus affects the heart and circulation.
The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review.
Schoenfeld SR, Kasturi S, Costenbader KH. Semin Arthritis Rheum. 2013 Aug;43(1):77-95. doi: 10.1016/j.semarthrit.2012.12.002. Epub 2013 Feb 17.
PMID:23422269 [PubMed - in process]
The Lupus Foundation of America is dedicated to overcoming barriers that have stood in the way of advancing the science and medicine of lupus. We thank Dr. Costenbader and her colleagues for their continuous efforts to help solve the cruel mystery of this devastating disease that impacts millions of Americans.
The results of this study indicate that current use of steroids (20 mg/day or more) is perhaps the most significant risk factor for heart disease in individuals with lupus.