Usually when we think of women with heart disease or at risk of heart disease, we think of someone in an older age group, and possibly in a setting of high blood pressure, diabetes, cholesterol, obesity, smoking or a family history of early age heart disease. These risk factors are called “traditional risk factors.”
Recently, the American Heart Association released 2011 updates on guidelines to prevent heart disease in women, and for the first time included lupus and rheumatoid arthritis as conditions that put women at an increased risk for heart disease. Is this truly a new risk factor?
Lupus is marked by inflammation in various organs, caused by the immune system’s fight against the body’s own cells. If this inflammation remains untreated or uncontrolled, it leads to damage, which becomes irreversible with time. This inflammation and damage can occur in any of the organs/systems of the body. Though some of the inflammation and damage may be visible to a patient or physician, e.g. in the skin or joints, frequently it may not be visible, perceptible or easily measurable.
To control the inflammation, corticosteroids are frequently used. Lupus patients may frequently have some of the traditional risk factors for heart disease, but some may be the results of the disease or its treatment, e.g. diabetes (from corticosteroid use, otherwise), blood pressure issues (from kidney involvement or otherwise), obesity (corticosteroids or decreased activity from organs inflammation or mood problems), cholesterol (corticosteroids). Untreated or uncontrolled inflammation in lupus may also add to the risk of heart disease.
Studies show a much higher risk of heart attacks and heart disease among women with lupus as compared to women of similar age. Some studies quote this risk to be more than 10 times than similar age women do, even after accounting for the presence of traditional risk factors. Even if we additionally account for use of corticosteroids, lupus patients remain at a much greater risk than other women do their age. Another study reports that 10 to 40 percent of lupus patients may have heart disease that has not yet manifested itself clinically.
Survival in patients with lupus has improved significantly with improvements in awareness, diagnosis and treatment. With better survival, we now need to be concerned about heart health and risk factors in lupus. Early screening of patients with lupus for presence of traditional risk factors and their addressal is pivotal to their heart and overall health. In addition, we need to be cognizant of use of corticosteroids and their associated side effects, and try to taper or discontinue them as soon as possible.
Hydroxychloroquine, a medication used universally in lupus, cannot only help with the disease activity; it also lowers cholesterol and triglycerides and has antithrombotic effects. It may also improve blood sugars and blood pressure control.
At the Rush Lupus Clinic, we are actively engaged in educating and providing cutting-edge care for our lupus patients and medical care providers. We applaud formal inclusion of these diseases in the heart risk assessment by the American Heart Association.