Lupus and coronary artery disease (atherosclerosis)

Recent studies report that people with lupus (systemic lupus erythematosus, or SLE) are at higher risk of developing plaque deposits in arteries (atherosclerosis) that may cause coronary artery disease (CAD).¹ Premature coronary artery disease is a prominent cause of illness and death in people with lupus.²

People with lupus develop atherosclerosis earlier in life than do people who do not have lupus.¹ This means that people with lupus are likely to have a greater risk of CAD and of having a heart attack (myocardial infarction) due to a complete blockage of the blood flow to a part of the heart muscle. Scientists are studying the role of lupus-caused inflammation in accelerating plaque development.³

One study found that people with lupus have more risk factors for developing CAD than do people who do not have lupus. These risk factors include inadequate thyroid hormone in the body (hypothyroidism) and onset of menopause an average of 4 years earlier than women without lupus. CAD poses a higher risk immediately before and after menopause. In addition to these factors, women with lupus had higher levels of "bad" cholesterol and were noted to lead less active lifestyles, in large part because of lupus-caused fatigue, arthritis, and reduced aerobic capacity.⁴ Aerobic capacity is the ability to do exercise such as walking and swimming that pumps oxygen to your heart and muscles.

To address this increased risk of atherosclerosis, some experts recommend that all people with lupus (regardless of presence of symptoms) be considered at increased risk for coronary artery disease.² Research continues for understanding and then guiding treatment of this increased risk.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) began a study in 2003 on the use of statins (medications used to lower "bad" cholesterol levels) to test their effectiveness in lowering the plaque buildup in children with lupus.

Citations

1. Roman MJ, et al. (2003). Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. New England Journal of Medicine, 349(25): 2399–2406.

2. Asanuma Y, et al. (2003). Premature coronary-artery atherosclerosis in systemic lupus erythematosus. New England Journal of Medicine, 349(25): 2407–2415.

3. Schattner A, Liang MH (2003). The cardiovascular burden of lupus. Archives of Internal Medicine, 163(13): 1507–1510.

4. Bruce IN, et al. (2003). Risk factors for coronary heart disease in women with systemic lupus erythematosus. Arthritis and Rheumatism, 48(11): 3159–3167.