Those Living with Lupus Are at Higher Risk of Atherosclerosis

Those living with lupus are at higher risk of getting blocked arteries due to the early development of atherosclerosis. New research indicates that vascular changes in lupus start quite early, much before any symptoms of vascular diseases appear. Understanding the risk of atherosclerosis, and taking early preventive steps may help to cut down mortality and improve the quality of life in lupus patients.

Lupus is a multi-organ autoimmune disease. Multi-organ means that it can affect the workings of just any organ. No two cases of lupus are identical. In some, it may start as an atypical rheumatic disease with a predominance of skin rashes and muscular-joint aches. However, in most cases, it may begin unexpectedly with diseases of the kidneys, brain, blood vessels, or heart.

Atherosclerosis is a disease characterized by the build-up of plaque in the arteries and thickening of arterial walls, thus disturbing the blood supply to various organs. If uncared for, it may cause stroke, kidney disease, or heart attack. There are multiple reasons for plague deposition in arteries, like sedentary lifestyle, high cholesterol, diabetes, along with autoimmune diseases and lupus.

There is a reason to worry about atherosclerosis, as those living with lupus are already at higher risk of developing various heart diseases like arrhythmia, inflammation of heart muscles (myocarditis), pericarditis, and endocarditis. Some may also develop defects of heart valves. Coronary heart disease is present in 6-10% of those living with lupus.

Those living with lupus are also at higher risk of developing blood clotting defects or thrombosis. In fact, thrombosis is among the leading causes of untimely deaths in lupus. It is estimated that approximately one-fourth of fatal outcomes in those living with lupus are due to complications arising because of thrombosis.

Development of atherosclerosis along with higher risk of cardiac diseases and thrombosis could be bad news for those living with lupus. It could substantially increase the risk of sudden death.

What did the latest research say?

Decreasing the risk of thrombosis, atherosclerosis may help to cut down the mortality rates in lupus. Considering that atherosclerosis develops gradually over a long time, its early detection may help to prevent it and related complications. A recent French study focused on the early detection of sub-clinical atherosclerosis.

The study named “Assessment of subclinical atherosclerosis in systemic lupus erythematosus: A systematic review and meta-analysis” was published in the journal Joint Bone Spine.

In young people living with lupus, a high activity of lupus or other acute complications like infections or thrombosis are the leading causes of death. However, things are different in older patients. In the elderly group, cardiovascular events are the leading cause of mortality, and worst of all, the rate of death due to cardiovascular events is rising in lupus. Higher prevalence of atherosclerosis is one of the reasons behind the upsurge.

Although, researchers have not been able to explain the reason for the high prevalence of various cardiac problems in lupus, and underlying mechanisms in the development of heart disease. Nonetheless, what studies have proven is that early detection and treatment can save many lives by preventing progress.

To fully understand the gravity of the problem, French researchers compared the frequency of atherosclerosis in those living with lupus with a healthy population. Atherosclerosis is not only about the buildup of plaques, but it is also about the thickening and stiffening of blood supplying arteries.

In atherosclerosis, the formation of plaque in the carotid artery, its thickening, and changes in blood flow in it are frequent. Carotid arteries are big arteries (two of them) that supply blood to the brain, and these blood vessels are easily palpable on the sides of the neck. As these arteries are not very deep, they are easier to scan and study.

French research team compiled the data from 68 studies regarding the changes in carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and carotid plaque presence. These methods are most commonly used to assess atherosclerosis. In total, they got the data of 5,248 people living with lupus, and 3,997 healthy participants.

The study of pooled data from 68 trials revealed that those living with lupus had significantly higher CIMT, which indicates the higher risk or cardiovascular events like stroke and myocardial infarction. The study also found that those with lupus were twice more likely to have carotid plaque.

They demonstrated that the prevalence of clinical or sub-clinical atherosclerosis is much higher in lupus as compared to healthy control subjects. Thus they concluded that there is a need evaluate the risk of cardiovascular complications from the very early stages of lupus. Although, more studies are required to fully understand the mechanism of atherosclerosis in lupus, for effective prevention and treatment.

Finally, there is a need to understand that risk of developing atherosclerosis and its complications may rise sharply in the presence of other risk factors like smoking, obesity, hypertension, high cholesterol, and diabetes.

Some of the drugs used to treat lupus may also increase the risk of atherosclerosis; it is especially true for corticosteroids.

So how to decrease the risk of atherosclerosis?

To decrease the risk of atherosclerosis and cardiovascular diseases, one must seek treatment of active lupus and other comorbidities like diabetes or hypertension. Further, lifestyle changes like quitting smoking, decreasing body weight, and making dietary changes can make a huge difference.

Exercise is another way to reduce the risk of atherosclerosis. However, one must not start an activity without consultation with a physician as some intense physical activities may increase the risk of specific complications.

One may also consult a doctor to start prophylactic drug therapy. Mostly, medical specialists may recommend low dose aspirin, other antiplatelet drugs, statins, folic acid, and vitamins B-complex.

In conclusion, it could be said that lupus dramatically increases the risk of heart disease, disorders of blood vessels, and blood-clotting defects. Early detection of these issues may help to initiate prevention therapy, thus helping to prevent the complications or even mortality.

References

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2. Henrot P, Foret J, Barnetche T, et al. Assessment of subclinical atherosclerosis in systemic lupus erythematosus: A systematic review and meta-analysis. Joint Bone Spine. December 2017. doi:10.1016/j.jbspin.2017.12.009
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