Ensuring a heart-healthy future
It’s often said that the course of lupus is unpredictable. While no one can see exactly what will happen in the future, it is crucial to do everything you can to prevent or mitigate the long-term impacts of having lupus.
This is especially true about lupus and heart disease.
Increased heart risks associated with lupus
Having lupus increases your risk for heart disease, which occurs when plaque builds up in the arteries and blocks blood flow to the heart. Lupus also increases the risk that a blood clot will block blood flow to the brain, which can cause a stroke.
“The risk factors for cardiovascular disease for people with lupus can be divided into two groups,” explains Murray Urowitz, MD, professor of medicine at the University of Toronto and director of the Centre for Prognosis Studies in the Rheumatic Diseases at Toronto Western Hospital:
- One is active disease—the ongoing inflammation that is the hallmark of lupus.
- The other is the classic risk factors, like high LDL (‘bad’) cholesterol, high blood sugar, smoking, high blood pressure, and being overweight.
Learning to balance acute care with wellness and prevention
According to a study published in the journal Arthritis & Rheumatology, hospitalizations for heart attacks and stroke in the US have risen over the past 16 years among people with lupus, even, most surprising of all, among women younger than 50. One of the possible reasons is a lack of awareness.
"Although rheumatologists are certainly aware of the increased cardiovascular disease risk factors among patients with lupus, primary care providers may not be,” says the report’s senior author Michael Ward, MD, MPH, chief of the Clinical Trials and Outcomes Branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, at the National Institutes of Health.
Hospitalizations for heart attacks and stroke in the US have risen over the past 16 years among people with lupus.
Another reason, suggests Dr. Ward, is that doctors may not be prioritizing preventive steps to decrease the risk of heart disease among their lupus patients.
“Primary care physicians are often concerned with an acute event that brings the person to the office for a visit, and they treat that event, whatever it is, and don’t necessarily think of checking cholesterol levels and blood pressure in young women,” says Dr. Urowitz.
Rheumatologists can commit similar oversights when faced with a patient having a lupus flare.
“The rheumatologists are very concerned about putting out the flare, and sometimes are slower in looking at the [long term] risk factors like cholesterol, blood pressure, and smoking,” he says.
A possible third reason for increased hospitalizations for heart conditions among people with lupus is that prevention measures may not be completely effective due to other lupus-related risk factors. Among these, says Dr. Urowitz, would be active disease, longer disease duration, older age at diagnosis, a history of kidney disease, the use of non-steroidal anti-inflammatory drugs (NSAIDs), and long-term use of corticosteroids.
Start now and lower your risk
It is never too soon to take preventive measures against heart disease and stroke.
There are a few simple things you can do to lower your risk:
- Exercise. Increase daily activity with low-impact aerobic exercise, such as walking at moderate intensity (i.e., your heart rate increases but you can talk).
- Improve your diet. Eat plenty of fresh fruits and vegetables, lots of whole grains, and moderate amounts of meat and fish.
- Quit smoking. Smoking increases your risk for heart disease as well as cancer and lessens the protective effect of certain medications, such as hydroxychloroquine (Plaquenil).
- Talk to your doctor. Ask about alternatives to NSAIDs for long-term pain management.
- Take control. Make every effort to help your doctor get lupus disease activity under control by taking you medications exactly as directed, tracking your symptoms and regularly scheduling and keeping doctor's appointments.