Heart Disease Often Goes
Hand in Hand With Lupus
by Gina Shaw
If you’re a young woman with systemic lupus erythematosus—more commonly known just as lupus—you already know that you face a number of additional health concerns that other women your age don’t have.
Lupus is a chronic autoimmune disorder in which the body’s immune system becomes hyperactive and attacks normal tissue, leading to inflammation. It most often affects women between the ages of 15 and 44. In addition to achy joints and extreme fatigue, women (and men) with lupus often experience arthritis and skin rashes, and are at higher risk of developing anemia and kidney problems.
Recently, doctors have identified another, even more serious health risk that goes hand in hand with lupus: heart disease. “About 35 percent of women who have lupus are going to die from heart disease,” said Dr. Rosalyn Scott, chief of cardiothoracic and vascular surgery at the Charles R. Drew University of Medicine and Science in Los Angeles and science and consulting medical director for the Association of Black Cardiologists. African American women are particularly at risk: Already facing elevated rates of heart disease, they also develop lupus at three times the rate of white women.
47;The concern about heart disease and lupus has been around for a long time, because we know women with lupus who’ve had open-heart surgery at 28,” said Margaret Dowd, president of the Lupus Research Institute, which has raised millions in funds for lupus-related research. “But it’s only within the last two years that new research has really documented the problem.”
One study, published in the New England Journal of Medicine in December 2003, found that lupus patients under 40 were nearly six times as likely to have plaque buildup than those without lupus—even when scientists controlled for traditional risk factors such as smoking, high blood pressure and high cholesterol. Other studies have found that women with lupus are also much more prone to some of those traditional risk factors, such as hypertension and diabetes.
“We’re seeing women in their 20s, 30s and 40s who have the cardiovascular systems of women in their 60s,” said Dowd.
Why does heart disease affect women with lupus so disproportionately and at such an early age? Scientists are still studying the relationship, but one key factor seems to be the inflammation that is characteristic of lupus. The heart can be directly weakened when there is inflammation of the heart muscle, its lining or the sac around the heart. Associated coronary artery disease—in which the heart’s vessels harden and narrow—is often caused by plaque buildup as a result of chronic inflammation and immune system abnormalities.
Another possible contributor is the death of endothelial cells (the protective cells that line every blood vessel in the body). Researchers at the University of Michigan in Ann Arbor last year reported that some people with lupus appear to develop early plaque buildup because these cells, which normally keep plaque and clots from forming, die at a faster rate and are replaced more slowly in people with lupus.
The Lupus Research Institute is now funding a number of scientific researchers as they study ways to identify lupus patients at particularly high risk for heart disease early on by using advanced cardiac imaging and biological markers. “Not everyone with lupus will develop heart disease, so it’s critical that we be able to identify who is at particular risk early on so that we can start them on preventive treatment,” Dowd said.
There are no specific treatments currently available for heart disease associated with lupus, but for example, women with lupus who have a particularly high heart disease risk might be treated with statins, which are commonly used to help stave off heart disease in other people at high risk. And if you know you have one risk factor for heart disease—lupus—it’s vital to keep your other risks at a minimum, said Dr. Gregory Dennis, director of clinical care and training at the National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Any other risk factor that’s present needs to be aggressively managed—which means smoking cessation, keeping at a healthy weight, managing diabetes and keeping blood pressure at normal levels.”
Women with lupus also frequently take corticosteroids to manage the symptoms of the disease—but these drugs can also cause high blood pressure and negatively affect something called lipid metabolism, potentially boosting heart disease risk. “Sometimes patients do have to have steroids because they’re one of the few treatments available for lupus right now, but women with lupus and their doctors should really work together to try to minimize the amount of steroids given,” said Scott.
Research advances are on the horizon, said Dowd. “We’re grateful to be getting a lot more applications for novel research in this area. We’re going to the scientific community and saying, ‘Give us your best new ideas on how to approach lupus,’ and a lot of it is emerging in cardiovascular disease.”
In the meantime, the Lupus Research Institute (LRI) is working to raise awareness about the connection between lupus and heart disease among at-risk women, their doctors and policymakers. In September, LRI and the Association of Black Cardiologists sponsored an educational session about lupus-related heart disease and its particular effects on women of color at the 35th Congressional Black Caucus Annual Legislative Conference.
“I would suspect that the average woman with lupus may not know about the connection with heart disease,” said Scott. “We’re hoping to get funding to have regional programs for physicians and for patients so that we can really get the word out.”
Gina Shaw is the medical writer for The Washington Diplomat.
