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The Link Between Lupus and Strokes

Medically Reviewed by Sabrina Felson, MD on March 14, 2022

Recent studies show that if you have the autoimmune disease lupus you’re at higher risk for a stroke. Systemic lupus erythematosus (SLE) is the most common form of lupus and makes up 70% of the cases.

In fact, if you have SLE, you’re eight times more likely to have a stroke compared with the general public. Strokes account for about 30% of the deaths among people with SLE.

Lupus and Stroke: What Are the Risk Factors?

A stroke happens when the blood vessels that carry nutrients and oxygen to the brain get blocked by a clot or bursts. Then, part of the brain loses oxygen and nutrients and brain cells begin to die.

When you have lupus, many things can increase your risk for a stroke. According to the experts, it could be medications, inflammation caused by lupus, or other medical conditions you may have.

Medical conditions. If you have another condition in addition to lupus, it’s called comorbidity. They may interact with each other and make your health worse. With lupus, certain comorbidities pose a higher risk for a stroke.

These include:

  • Vasculitis. A condition in which blood vessels or the blood vessel walls become inflamed. It causes the wall to thicken which can restrict blood flow. In some cases vasculitis is thought to be an autoimmune disease, which means the body comes under attack by its own immune system. In vasculitis, the immune system attacks blood vessels.
  • Antiphospholipid syndrome (APS). It’s a type of autoimmune condition that causes clots in veins and arteries. APS can also cause miscarriages.
  • Hypertension. Also known as high blood pressure, it’s the pressure your blood exerts on the walls of the arteries. This causes damage to the vessel wall and blood flow, which can lead to clot formation.
  • Premature atherosclerosis. It’s a condition that hardens and narrows your arteries. It can happen when you’re relatively young. The arteries over time can become blocked, which cuts off normal blood flow.
  • Chronic inflammatory diseases. When you’re sick or injured, your immune system sends out inflammatory cells to destroy bacteria or repair damaged cells. But if your body releases these cells when you’re not sick or injured, this causes chronic inflammation. Inflammation increases the chance of stroke.
  • Libman-Sacks endocarditis. It happens when the endocardium, the innermost layer of your heart, is injured and it becomes inflamed. It’s a common condition to have along with lupus.
  • Immune deposits in your body. When foreign particles called antigens, like a virus or bacteria, enter your body, your immune system releases antibodies to fight them. The antibodies bind to antigens to create immune complexes which may deposit themselves in organs or blood. It’s part of your normal immune response but if there’s too much build-up, it can cause issues like vasculitis.

Race and ethnicity. Studies show Black, Asian, and Hispanic people with SLE have a much higher risk for stroke compared with other races. The risk is even higher if people of color who have lupus also have:

In such cases, studies note that early detection and screening for risk factors among people of color with lupus can lower your chances of having a stroke.

Age. Younger people with lupus are at higher risk for a stroke. According to research, you’re twice as likely to have a stroke if you have SLE and are under 50. One study that looked at 4,451 people found that the median age for a stroke when you have lupus was 34.

Is It a Stroke or Lupus Fog?

It’s important to note that common lupus symptoms like brain fog can also mimic stroke-like symptoms. Also known as lupus fog, it affects about 70% to 80% of people and can cause cognitive symptoms, like having a hard time thinking clearly or remembering things.

Other common lupus fog symptoms include:

  • Confusion and trouble concentrating
  • Difficulty multitasking
  • Having a hard time finding the right word
  • Needing to read things multiple times or not being able to keep up with a conversation
  • Taking a long time to solve problems or make plans

If you notice these symptoms, let your doctor know about them so they can rule out a possible stroke.

Things You Can Do to Lower the Risk of Stroke

Around 80% of strokes are preventable. With small changes to your diet and overall lifestyle, it’s possible to significantly lower the risk of having a stroke.

You should:

Eat a healthy diet. A well-balanced way of eating with whole grains, foods low in fats and cholesterol, fiber, fruits, and vegetables will keep your physical health in check. Before you try a new diet or cut foods, talk to your doctor about it. If you have access to a nutritionist or a licensed dietician, they can help come up with a meal plan that works best for you.

Lower alcohol intake. If you drink and have lupus, consider drinking only in moderation. The medicines you take can interact with alcohol leading to several side effects. For example, several meds that are used to treat lupus when mixed with alcohol can lead to liver damage.

Exercise more. Regular exercise can help keep your weight and blood pressure in check. It can also lower bad cholesterol and glucose levels. All of this reduces your risk for a stroke.

Aim to move your body with moderate exercise for at least 30 minutes a day around five times a week. This can include walks, taking the stairs, swimming, or biking. If you’re new to exercise, start slow and add intensity to your exercises as you build up strength and stamina over time.

Quit smoking. Cigarette smoking can thicken your blood and put you at risk for clots. It can also cause plaque to build up in your blood vessels. Cutting back on smoking will greatly reduce your risk for stroke. Talk to your doctor for advice on how to quit smoking. You can try smoking alternatives such as nicotine pills or patches, counseling, or medicine to help you get started.

Lower blood pressure. Healthy meals and snacks, regular exercise, and low caffeine intake can help lower your blood pressure. Try gentle movements like yoga, tai chi, medication, and other complementary practices like cognitive behavioral therapy to improve overall well-being.

A healthy blood pressure target is typically around 130/80. It can change slightly if you have lupus-related kidney issues. If you’re unable to control your blood pressure, your doctor may prescribe drugs to help your body regulate it.

Manage cholesterol. Healthy meals and exercise can help lower your bad cholesterol levels. But sometimes lifestyle changes aren’t enough. If this is the case, your doctor may prescribe statins or hydroxychloroquine, a class of drugs designed to lower cholesterol levels and prevent clots.

Show Sources

SOURCES:

Lupus Foundation of America: “Lupus and Brain Fog,” “What is systemic lupus erythematosus (SLE)?” “New Insights Emerge on the Link between Lupus and Stroke,” What is Lupus?”

Kaleidoscope Fighting Lupus: “Lupus and the Risk of Stroke.”

Mediterranean Journal of Rheumatology: “Cerebrovascular Events in Systemic Lupus Erythematosus: Diagnosis and Management.”

Seminars in Arthritis and Rheumatism: “Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus.”

American Stroke Association: “About Strokes.”

Harvard Health: “7 things you can do to prevent a stroke.”

Cleveland Clinic: “Inflammation.”

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