Lupus and Cardiac Disease Part II

As mentioned in my previous post about heart disease and lupus, I decided to do a little research to find out why lupus patients are at such an increased risk of cardiac disease. I knew a little bit, probably just enough to be dangerous, but I decided to find out more. 


The good news is that the answers I was looking for were readily available online, which was oh-so-convenient for this research-averse blogger. However, in order to obtain what I considered a satisfactory answer, I had to pull from about five or six different sources. And the fact that finding those answers took some digging explained a lot. 


It explained why I was a little bit muddy on the subject. After 11 years with lupus, it's not that I didn't know anything about lupus and the heart. It was just that, up until now, most of the information I came across online, in books, or in pamphlets stressed the traditional risk factors as the primary concerns for people with lupus. Things like keeping to a healthy weight, watching your cholesterol and blood pressure, and staying active were mentioned in almost every "lupus and the heart" article I'd ever come across. And of course that advice is sound. But what it mistakenly led me to conclude was this: since, as lupus patients, our risk to those traditional factors are increased (due to debilitating pain that keep us from being active, or steroid therapy that causes weight gain), if I wasn't showing signs of those traditional risk factors, then I was pretty much in the clear. 


Well - I should have known better. After all, the primary concern of my pulmonologist during the first 6 months after I was diagnosed was that the inflammation and fluid in my lungs was migrating over to my heart. Good news is that the fluid never got there...and because it didn't, I kind of dismissed the heart concerns. 


But I shall dismiss no longer. Here are the reasons why lupus patients are more prone to cardiac disease:


*ANTI-BODIES: Many lupus patients have antibodies that attack proteins that help regulate blood vessels. The presence of those guys can increase the risk of heart attack, stroke, and heart disease. 


*INFLAMMATION: Chronic inflammation, when found around the heart, in the muscle tissue, or in the inner lining of the heart, can interfere with the heart’s ability to function properly. Interestingly, inflammation in the muscle tissue can also be caused by infection, which as lupus patients we are prone to, particularly when on immunosuppressive drugs. 


*MEDICINE: Corticosteroids, with prolonged use, can be real trouble makers. They can cause increased risk for diabetes, elevated cholesterol, and hypertension - all of which can contribute to heart disease.


*KIDNEYS: Hypertension (which leads to heart disease) can also be caused by kidney disease, which many of us have. Dinged again! 


*CHOLESTEROL- We usually think of HDL as the good guys, and LDL as the bad guys. But it turns out that abnormal, pro-inflammatory HDL (piHDL) can exist in people with lupus and other autoimmune diseases, likely contributing to atherosclerosis. In fact, the presence of piHDL may serve as a biomarker to identify women with lupus who have the highest risk of cardiovascular disease so more intense preventive steps can be initiated. (That is GOOD news!)


The links below can give you details on each of the issues outlined above, and many thanks to the sources listed. Note that by no means is the information provided meant to say that as lupus patients, we're doomed. That's hardly the case! 


It's just important to know that if there are several factors inherent to lupus that we cannot control, it's that much more important to do something about the factors that we CAN control. Nutrition, exercise, healthy lifestyle, low stress (to control disease activity AND blood pressure)...it all adds up, ideally to a healthy heart!


Sources:


Lupus Foundation - Heart Disease is a Major Complication of Lupus
Pittsburgh Magazine - Dr. Susan Manzi: Unmasking the Great Impersonator
Lupus Foundation - Chat Transcript with Dr. Susan Manzi
Alliance for Lupus Research - Cardiovascular Disease and Lupus
Lupus Foundation - The Cardiopulmonary System 
Rx PG News - Pro-inflammatory HDL biomarker for Lupus Atherosclerosis