Risk of Heart Attack and Stroke in Lupus

Lupus is an autoimmune disease in which the patient’s own immunity attacks the patient’s body. Any organ can be affected and ranges from mild to very severe forms with kidney and brain involvement. Survival in lupus has improved significantly over the past few decades. In 1950s 50% of patients die within 5 years of diagnosis but now a near normal life span is expected. New problems have emerged with longer duration of disease. Now major issues leading to higher risk of death and disability are infections, heart attacks and strokes.

Heart attack occurs when blood supply to a portion of heart muscle gets interrupted. As we grow older, the arteries get stiff and cholesterol gets deposited along the walls. Over time, clots form and bits of cholesterol break off from the arterial wall lining and get in the way of blood flow. The muscle in that area dies, leading to chest pain and loss of function in that part of the heart. Patient will then experience the typical symptoms of chest pain, shortness of breath and increased sweating. Some patients may feel the pain in the upper arm and jaw. Nausea, vomiting or sudden dizziness can also occur. Stroke happens when blood supply to a certain part of the brain is suddenly interrupted. Symptoms are variable, depending on the area and extent of brain that is affected. Most drastic is the inability to move one side of the body but it can range from silent damage to severe disability.

The risk of heart attack and stroke is increased in lupus. All patients, even young women, have 5-10% higher risk than their healthy counterparts. This is due to many reasons including inflammation, sticky blood and more risk factors in patients with Lupus. The general risk factors include high blood pressure, elevated cholesterol levels, diabetes, obesity, smoking, and inactive, sedentary lifestyle. Lupus-specific risk factors include  active disease, longer disease duration and long-term corticosteroid use.

The risk can be reduced by controlling the risk factors and Lupus activity. You can help to reduce the risk by having an active life style. Exercise regularly but avoid sudden bouts of heavy exercise. Develop a routine that suits your condition. Watch your diet, maintain your weight, avoid smoking and take your medicines regularly. Good control of blood pressure, cholesterol and diabetes will significantly lower the risk of heart attack and diabetes in all patients, including patients with Lupus.

Disease Control is very important as uncontrolled disease with more inflammation translates into higher risk of heart attack and stroke. You should consult your doctor regularly and take your medicines as prescribed. Corticosteroids and other medicines (such as Imuran, Cellcept, Cyclophosphamide) can sometimes cause side effects but they are necessary to control the disease, which in turn results in lowering the risk of heart attack and stroke. If you encounter problems, discuss with your doctor and explore options. Do remember, close co-operation between patient and doctor is required to achieve a good disease control.

Author: Dr Aisha Lateef