If you have lupus, the risks go far beyond joint pain and skin rashes. Research shows that people with lupus are at significantly higher risk of heart attacks and strokes, even at a young age. The good news is that there are steps you can take to protect your heart.
How Big Is the Risk?
A landmark study in the New England Journal of Medicine found that women aged 35–44 with lupus were 50 times more likely to suffer a heart attack compared to women without lupus. A meta-analysis of over 100 studies confirmed a 2–10 times higher risk of cardiovascular events, including stroke and coronary artery disease.
The main drivers include:
-
Chronic inflammation
-
Accelerated atherosclerosis
-
Endothelial dysfunction
-
Prothrombotic state, especially in those with antiphospholipid antibodies
Even when no symptoms are obvious, arterial plaque can develop early and be detected through imaging.
What Do Imaging and Labs Show?
-
Carotid ultrasound: shows thicker artery walls and early plaque buildup
-
PET and MRI angiography: reveal vascular inflammation without symptoms
-
Blood tests: CRP, interleukin-6, homocysteine, and lipoprotein(a) are often elevated and linked to higher cardiovascular risk
Why Traditional Risk Scores Fall Short
Tools like the Framingham risk score underestimate lupus risk because they ignore chronic inflammation, autoantibodies, and the unique impact on women. Rheumatology-specific tools such as the Lupus Cardiovascular Risk Index are being developed.
The Role of Medications
-
Hydroxychloroquine (Plaquenil): improves cholesterol balance, reduces clotting risk, and lowers insulin resistance. One study showed a 70% reduction in thrombosis risk.
-
Methotrexate: reduces inflammation and lowers cardiovascular mortality in rheumatoid arthritis, with likely similar benefits in lupus.
-
Belimumab (Benlysta): decreases B-cell activity and slows atherosclerosis progression.
-
Rituximab (Rituxan): still under study, but reduces inflammation which supports vascular health.
-
Steroids: helpful for flares, but long-term use raises blood pressure, cholesterol, and diabetes risk. Steroid-sparing approaches are preferred.
Lifestyle Steps That Protect Your Heart
-
Anti-inflammatory diet: Mediterranean style with omega-3 fats, vegetables, and fiber while limiting processed carbs and sugars.
-
Exercise: At least 150 minutes of moderate activity per week plus strength training. Even low-impact options like water aerobics or walking are beneficial.
-
Quit smoking: Smoking worsens lupus flares and doubles clot risk.
-
Manage stress: Cortisol and catecholamine spikes from stress increase inflammation. Mindfulness and quality sleep are key.
What Labs to Monitor
In addition to standard lupus tests, ask your doctor about:
-
High-sensitivity CRP
-
Fasting insulin and glucose
-
Triglyceride-to-HDL ratio
-
LDL particle size
-
Homocysteine
-
Lipoprotein(a)
-
Vitamin D levels
FAQs About Heart Health in Lupus
Should lupus patients take statins?
Maybe. If you have high LDL cholesterol or confirmed plaque buildup, statins can lower risk. If inflammation is the only issue, lifestyle and anti-inflammatory medications may be enough.
Can heart disease risk go down if lupus is in remission?
Yes. Lowering disease activity reduces vascular inflammation, and remission is linked to lower cardiovascular risk.
Can I still exercise if I have lupus joint pain?
Absolutely. Choose low-impact options like swimming, walking, or light strength training. Regular activity improves heart health and reduces inflammation.
The Bottom Line
If you live with lupus, your cardiovascular risk is real but manageable. Lowering disease activity, using the right medications, and following lifestyle strategies can significantly reduce your risk. The earlier you act, the better protected your heart will be.
Lupus Explained: Symptoms, Causes, and How It Affects Your Body
Lupus and Mental Health: How to Manage Fatigue, Brain Fog, and Depression
The Lupus Flare Cycle: Triggers, Symptoms, and How to Manage Flares Effectively