Lupus and Heart Disease

Medically Reviewed by Sabrina Felson, MD on March 08, 2024
4 min read

Lupus, an autoimmune disease in which the body attacks its healthy tissue, affects people in lots of different ways. The painful, damaging inflammation it causes can occur not just outside, on your skin, but also in organs such as your kidneys and lungs.

Over the long term, lupus also raises your risk for cardiovascular disease (CVD), a group of conditions that affect your heart and blood vessels. CVD is the leading cause of death for people with systemic lupus erythematosus (SLE), the most common type of lupus.

The inflammation that results when your immune system turns on itself can harm the thin inner lining of your blood vessels, known as the endothelium. This can cause CVD to start earlier in life than usual. That’s especially true for young women with lupus, who are 50 times more likely to have a heart attack than women in the same age group without SLE.

The steroids used to treat lupus can also damage your heart health because they may lead to high blood pressure, high cholesterol, and diabetes. These conditions raise your risk of heart disease, which goes up when you take higher doses and spend more time on steroid medications.

The risk of heart disease is much higher in people with lupus than in those without it. More than half of patients with SLE will get cardiovascular conditions related to their lupus. These include:

Atherosclerosis: This is the most frequent type of CVD in people with lupus. It happens when cholesterol and other substances build up in your arteries. Eventually, this buildup -- called plaque -- restricts the flow of blood to your heart, brain, feet/legs, and other parts of your body.

Inflammation of the heart: When inflammation affects the pericardium, or the sac around your heart, it’s called pericarditis. It affects around 1 in 4 people with SLE. You may be especially likely to get pericarditis when your lupus symptoms flare up. Inflammation also can strike your heart walls and valves, a condition called endocarditis, and your heart muscle, which is known as myocarditis.

Vasculitis: This inflammation in your blood vessels stops the normal flow of blood to some organs.

Hypertension (high blood pressure): It affects about half of people with lupus, and raises your risk of heart failure and heart attack.

Antiphospholipid antibody syndrome (APS): APS can cause clots in the vessels that supply blood to your brain, heart, or lungs. These clots can cause heart attacks and strokes.

Problems with blood vessels under your skin: These include conditions, such as Raynaud’s phenomenon, livedo reticularis, and palmar erythema, that can change the look and color of your skin.

Most of these conditions can lead to other CVD problems as well. People with SLE are more likely than others to have:

If you have lupus, stay alert to how you feel. Common symptoms of an inflamed heart, for instance, include:

  • Chest pain
  • Swelling throughout your body
  • Fatigue when you’re active
  • Difficult or painful breathing
  • Problems with your heartbeat

Symptoms of vasculitis include fever, weight loss, rash, and eye or brain problems. White or blue fingers and toes, red palms, and lacelike patterns on your skin are signs of problems with blood vessels just beneath your skin’s surface.

The complicated heart and blood vessel problems that lupus can cause may mean you need a team of doctors from several specialties. Together, they can design a treatment plan to lower your risk of CVD and treat any problems you do develop.

To start, ask your primary care doctor about any concerns related to lupus and your heart. You may or may not need to see a cardiologist or heart doctor. The decision depends on whether you’ve had any symptoms and whether you have other risks for CVD besides lupus (for instance, 

Cardiologists can order tests to check your heart health. They also can work with the doctor who treats your lupus to adjust your medications to help protect your heart against future disease.

The tools used to diagnose CVD depend on which condition your doctor suspects. They include:

  • Blood tests (to measure cholesterol, for example)
  • Angiography (chest X-rays that look at blood flow to and within your heart)
  • Electrocardiography, commonly called an EKG or ECG, to tracks your heart’s electrical activity
  • Echocardiography to check how well your heart’s valves and other parts are working

Your doctor will tailor your treatment to your particular issues. To address the long-term risks posed by atherosclerosis, for example, you may need to take a statin, a drug that controls your cholesterol. For pericarditis, your doctor may prescribe steroids or NSAIDs, which are drugs that reduce inflammation and pain.

If you have myocarditis, your doctor will want to keep a close eye on your condition and treat you with high-dose steroids. For endocarditis, they may prescribe antibiotics to prevent or treat infection, and you may eventually need surgery to replace an infected valve.

Even with the challenges posed by lupus, you can take steps to protect your cardiovascular health:

  • Don’t smoke
  • Follow a low-fat, low-cholesterol diet that focuses on unprocessed foods like whole grains, vegetables, and lean protein
  • Keep your salt intake low
  • Maintain a healthy body weight
  • Exercise at least 30 minutes a day (low-impact activities such as yoga and swimming may be a good fit if you’re having lupus symptoms such as joint and muscle pain)