Heart Disease and Lupus

Lupus patients can suffer from additional risk factors that increase their chances of developing heart problems compared to the general population. In fact, according to the Johns Hopkins Lupus Center, the number one cause of death in lupus patients is cardiovascular disease, not lupus itself. This article will discuss common heart diseases associated with lupus and how to lower the risk of developing them.

*Disclaimer:

The information provided in this article is for general informational purposes only and is not intended as medical advice. It should not be used as a substitute for professional diagnosis, treatment, or advice from a qualified healthcare provider. Reliance on any information provided in this article is solely at your own risk.

See a word you don't understand? Find it in our glossary.

Healthy arteries are elastic. However, irregular blood vessels comprising the arteries may thicken and stiffen, restricting blood flow. This is called arteriosclerosis, and it is primarily a natural result of aging.

Atherosclerosis is a specific type of arteriosclerosis. The narrowing of the arteries is caused by the buildup of plaque made up of fats, cholesterol, and other substances in and on the artery walls. Lupus patients are particularly susceptible to atherosclerosis. A 2023 study found that over a 7-year follow-up period, lupus patients had a 4-fold higher risk of plaque progression than healthy individuals. Additionally, the American College of Cardiology reports that the relative risk of atherosclerotic cardiovascular disease can jump to 50-fold if the patient is young, has more severe lupus activity, or has lupus nephritis.

Early on, symptoms of atherosclerosis might not manifest until it worsens into further complications and diseases, such as:

• Coronary artery disease (reduced blood to the heart)

• Carotid artery disease (reduced blood to the brain, which can lead to strokes)

• Peripheral artery disease (reduced blood to the limbs)

• Aneurysms

• Chronic kidney disease

To lower the risk of atherosclerosis, try to cut out smoking or usage of other tobacco products, exercise regularly, and sleep well. Furthermore, a diet that focuses on heart-healthy foods that are low in salt, saturated fats, and trans fats can lower the risk of atherosclerosis. Examples of foods in a heart-healthy diet include:

• Fish high in omega-3 fatty acid

• Fruits and vegetables

• Plant-based and/or lean sources of protein

• Whole grains

Pericarditis is the most common heart problem associated with lupus. It refers to the inflammation of the thin sac around the heart called the pericardium. Pericarditis may involve liquid leaking around the heart as well. Typically, development of pericarditis is sudden, characterized by sharp chest pain, and can last from weeks to months. Approximately 25% of lupus patients develop pericarditis.

Pericarditis can also come back after an initial episode. A 2025 study found that approximately 20% of lupus patients experienced recurrent pericarditis, and 49% of those patients who developed recurrent pericarditis had more than one recurrence. Younger lupus patients or lupus patients with severe lupus activity were more likely to experience recurrent pericarditis. Furthermore, the risk of recurrence was higher within one year of the initial episode. As such, close monitoring of patients with pericarditis is pivotal.

Besides a sharp, stabbing chest pain, pericarditis can include:

• Trouble breathing when lying down

• Dry cough

• Heart palpitations

• Fatigue

• Fever

• Swelling in the legs, feet, and ankles

Much like preventing atherosclerosis, lowering the risk of pericarditis involves avoiding tobacco products, regularly exercising, and following a heart-healthy diet.

Furthermore, medicine alone is often prescribed to treat pericarditis. If you or a loved one has lupus and is suffering from pericarditis, a doctor may prescribe:

• NSAIDS, such as Ibuprofen or high-dose aspirin

• Antibiotic or antifungal medicine

• Colchicine

• Prednisone

However, researchers have found that prednisone may lead to recurrent pericarditis. Always discuss recurring symptoms with a doctor and stay informed about the medications and treatments available.

Endocarditis is life-threatening inflammation of the inner lining of the heart’s chambers and valves. The inner lining is called the endocardium. While endocarditis is typically caused by a bacterial, fungal, or other infection, lupus patients are most susceptible to Libman-Sacks endocarditis. About 15% of lupus patients have Libman-Sacks endocarditis, which is non-bacterial and instead linked to antiphospholipid antibodies.

Typical antibodies protect the body and destroy harmful substances however, antiphospholipid antibodies are abnormal antibodies that attack proteins bound to phospholipids. 50% of lupus patients have antiphospholipid antibodies.

Symptoms of endocarditis can include:
• Joint and muscle aches
• Chest pain
• Fatigue
• Fever
• Shortness of breath
• Swelling in the feet, legs, or belly
• Heart murmurs

If you or a loved one is at high risk of endocarditis, the American Heart Association recommends antibiotics before dental work, as certain procedures can allow bacteria to enter the bloodstream. Furthermore, always maintain good care of the teeth and gums.

Heart problems impact many people with lupus, often more severely than healthy individuals. Lupus patients are especially susceptible to cardiovascular diseases such as atherosclerosis, pericarditis, and endocarditis, and may even develop such diseases again after recovery from an initial episode. To lower the risk of developing these cardiovascular diseases with lupus, eat a heart-healthy diet, exercise regularly, maintain good dental health, stay away from tobacco, and discuss symptoms often with a doctor.

How Does Lupus Affect the Cardiovascular System | John Hopkins Lupus Center

Arteriosclerosis / atherosclerosis | Mayo Clinic

The impact of traditional cardiovascular risk factor control on 7-year follow-up atherosclerosis progression in systemic lupus erythematosus | Rheumatology

Atherosclerotic Cardiovascular Disease Risk Prediction in Systemic Lupus Erythematosus | American College of Cardiology

What Should You Eat (or Avoid) if You Have Lupus? | Cleveland Clinic

Impact of Lupus on Heart Health | Lupus Foundation of America

Vascular Disease (Vasculopathy) | Cleveland Clinic

Pericarditis | Cleveland Clinic

Incidence and Factors Associated With Recurrent Pericarditis in Lupus | JAMANetwork

What to Know About Lupus Pericarditis | Healthline

Endocarditis | Mayo Clinic

Antiphospholipid Syndrome | Cleveland Clinic

Infective Endocarditis | American Heart Association