5 Ways Lupus Can Hurt Your Heart

Lupus is an autoimmune disease that causes inflammation throughout your body. It’s most widely known for damaging your skin and joints. But did you know that lupus can also hurt your heart?

“The major cause of death if you have lupus is heart disease,” said Marcia Johnson, MD, a rheumatologist at Franciscan Health Lafayette East. “It’s actually about 50 times higher for a woman who is 35 to 44 if she has lupus.”

According to a 2022 study published in the journal Lupus, the risk of cardiovascular disease, heart attack and stroke is two to three times higher in someone with lupus. A 2020 study published in Arthritis Care & Research revealed that people with lupus who are 18 to 35 have a higher incidence of heart attack or stroke than people without the condition who are 50 to 65.

Having lupus boosts your risk of coronary artery disease and other heart conditions. Fortunately, you can take steps to protect your heart health. To do that, it’s important to know how lupus-related inflammation can affect different parts of your heart.

Key Takeaways: Lupus And Your Heart

• Women with lupus are 50 times more likely to have a heart attack than women in the general population.
• Lupus raises a woman’s risk of developing several heart conditions.
• Inflammation damages your blood vessels and leads to cholesterol buildup, which can contribute to heart disease.

Coronary Artery Disease

Lupus raises your risk of heart disease, including coronary artery disease and atherosclerotic heart disease. Coronary artery disease happens when plaque builds up in your arteries and decreases blood flow to your heart. When that blood flow is completely blocked, you can have a heart attack.

According to a recent study in JAMA Dermatology, people with lupus who have skin problems are 72 percent more likely to develop atherosclerotic heart disease. This condition develops when your arteries are clogged and become less flexible.

Pericarditis

Pericarditis is inflammation in the sac around your heart. Symptoms include:

• Chest pain
• Pain with deep breathing
• Shortness of breath

Inflammation can also cause fluid to leak and collect around your heart. Doctors can see the fluid collection on an electrocardiogram (ECG), a quick, noninvasive test that measures your heart’s electrical activity. Although symptoms can improve when you lean over, this condition can be extremely painful. As a result, many people seek help in the emergency room.

“If the pericardial effusion, or fluid around your heart, is too large, your heart can’t pump well,” Dr. Johnson said. “That’s incredibly serious, and you end up in the ICU. It’s something we see in about 25 percent of patients with lupus.”

Endocarditis

Endocarditis is inflammation in the heart walls and valves. This life-threatening condition is triggered by a bacterial infection that enters your bloodstream. It causes platelets and fibrin, a blood-clotting protein, to collect and build up in your heart valves. These clumps can break off, form blood clots and cause a stroke or heart failure.

Myocarditis

Myocarditis is inflammation of the heart muscle. Symptoms can include:

• Chest pain
• Fatigue with activity
• Irregular heartbeat
• Swelling

“Myocarditis is rare, thank goodness,” said Dr. Johnson. “If the inflammation is severe, it can impair your heart’s ability to pump. It can also affect the conducting system, the electrical system around the heart.”

Heart Valve Disease

Although uncommon, lupus can affect your heart valves. Instead of infection, it can cause growths on your valves.

“If you have growths on your valves, you’re at a high risk of getting an infection,” Dr. Johnson said. “It changes the structure of your valves, and it’s called Libman-Sacks endocarditis. It carries a higher risk of stroke if those clumps were to break off.”

How Inflammation With Lupus Contributes To Heart Disease

Inflammation, caused by lupus or another rheumatologic condition, increases your risk of heart disease. Over time, inflammation scars and narrows your blood vessels, said Anthony Bashall, MD, a board-certified cardiologist at Franciscan Health. It also creates small cracks and holes in the vessel walls that cholesterol can fill in.

“When the lining of the blood vessel is damaged, cholesterol often jumps in and starts to plug the vessel,” he said. “This is what leads to the bad and ugly outcomes like heart attacks and strokes.”

Taking steps to reduce your inflammation can lower your risk of blood vessel and heart damage.

Lowering Heart Disease Risk When You Have Lupus

Two key steps can help you lower your risk of heart disease when you have lupus. “Get lupus in remission if you can. Studies show that the classic lupus drug — Plaquenil or hydroxychloroquine — can decrease your risk of heart disease by 50 percent,” Dr. Johnson said. “You should also do the regular things we recommend if you have heart disease, including diet, exercise, monitoring cholesterol and not smoking.”

As your main healthcare partners, your primary care physician and lupus doctor can help manage your risk of heart disease. And, in some cases, a cardiologist can find out if you have lupus-related heart problems. If you have symptoms of heart problems, they may recommend one or more of these tests:

• Blood tests
• Chest X-rays
• ECGs
• Echocardiograms (tests that use sound waves to see inside your heart)
• High-sensitivity C-reactive protein (a new blood test that can detect chronic inflammation)

Franciscan Health’s rheumatology and cardiology teams can evaluate your lupus and risk of heart disease. We’re ready to help you create the right treatment plan that meets your needs.

Connect with a rheumatologist or cardiologist. Find a specialist near you or schedule an appointment online.