LUPUS and Heart

Article by Michelle Dew, MD, FACC AdventHealth Cardiology

May is Lupus Awareness Month. Lupus is a chronic autoimmune disease impacting various organs, with three main types: Systemic Lupus Erythematosus (SLE), Cutaneous Lupus Erythematosus, and Drug-induced Lupus. It predominantly affects women aged 15-44, particularly black and Hispanic women, with the latter group experiencing more heart-related issues. Risk factors such as diabetes, high blood pressure, and unhealthy weight are prevalent among lupus patients. Particularly, black patients face a higher risk for coronary artery disease (CAD) due to several factors, including higher kidney involvement and limited access to medical care.

Diagnosing lupus is challenging due to its varied symptoms, which can range from joint pains and skin rashes to severe kidney, blood, nervous system, and heart disorders. The disease’s autoimmune nature leads to the body attacking its organs with antibodies, complicating the diagnosis process, which may include blood tests, urine studies, biopsies, and MRI.

Heart-related complications of lupus encompass issues with the coronary arteries, heart valves, electrical system, pericardium, and heart muscle. Pericarditis is the most common heart issue, occurring in about 25% of lupus patients and often signaling the disease’s onset. It starts with pain that worsens upon inspiration and can be difficult to treat.

Myocarditis, inflammation of the heart muscle, can lead to severe illness, pain, fevers, and even heart failure, impacting the heart’s pumping function. Diagnostic tools like cardiac MRI are crucial for identifying myocarditis.
Lupus patients have a higher risk of CAD due to chronic inflammation, which can lead to atherosclerosis, heart attacks, and the need for stents or bypass surgery. Young women with lupus are particularly at risk for obstructive CAD.

Inflammation can also affect heart valves, causing conditions like Marantic Endocarditis, which affects up to 11% of SLE patients, primarily impacting the mitral or aortic valves. Diagnosis often involves an echocardiogram.
Lupus can lead to heart rhythm issues even before birth in babies of women with active lupus. Moreover, up to 50% of lupus patients experience Raynaud’s phenomenon, where cold triggers spasms in blood vessels, causing color changes in fingers from white to blue to red.

Vasculitis, or inflammation of blood vessels, is another complication, with lupus affecting vessels of all sizes and leading to a higher risk of blood clots in arteries and veins.

Treatment focuses on managing symptoms and reducing inflammation. Steroids, while a mainstay of treatment, can exacerbate cardiovascular risk factors. Statins and immunosuppressive drugs are also used to manage inflammation. Protective measures like avoiding sun exposure and using sunscreen with a minimum of SPF 30 are essential due to light sensitivity.
In summary, lupus poses significant challenges in diagnosis and treatment, particularly with its impact on heart health. Management strategies involve a combination of medication, lifestyle adjustments, and regular monitoring to mitigate the risk of serious cardiovascular complications.

This version aims to capture the essence of the original text while adhering to the word limit constraint, focusing on the critical aspects of lupus’ impact on the heart and overall health.

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