Change of Heart -- Lupus

[Carolyn, Director]

Change of Heart - New Guidelines for Cardiovascular Health for Women
by Emily Wojcik

You know that heart health is important, but when you’re juggling work and home life, keeping heart healthy through diet and exercise can be tough. For people with lupus, especially women, those little slips can spell big trouble. Lupus and its treatment often create problems, says Amy Kao, M.D., M.P.H., assistant professor of medicine at the University of Pittsburgh’s Lupus Center of Excellence. "People with lupus may be more likely to be physically inactive or develop excessive weight gain from steroids," she says. "Lupus itself can cause increased cardiovascular-disease risks, such as hypertension -- especially among those with lupus nephritis."

Another issue? Gender. Many people assume that heart disease primarily affects men, but according to the American College of Cardiology, cardiovascular disease is the number one cause of death among women worldwide. Women with lupus, specifically, are up to 50 times more at risk for a heart attack than healthy women.

But it’s not all doom and gloom. The American Heart Association updated its guidelines for all women, and while they don’t include lupus-specific research guidelines, Kao says the general recommendations provide a good starting place. She and other investigators are working to determine the effectiveness of certain lifestyle changes and medications on heart health for women with lupus. No conclusions have yet been reached.

In the meantime, Kao says that the key is to approach cardiovascular health with a clear understanding of your risk. "Some researchers believe women with lupus should be treated at the same risk level as women with diabetes, which means the age group for prevention and treatment is likely much younger than that of women in the general population," she says. In other words, it’s never too early to start paying attention.

Read transcripts of Dr. Kao’s Web chats at lupus.org in the chat archive section.

Heart-Healthy Do’s and Don’ts

Because the American Heart Association (AHA) guidelines for women don’t address lupus specifically, we’ve summarized some of the guidelines into this useful list of Do’s and Don’ts, and Amy Kao, M.D., has provided additional information specific to lupus. Always talk to your physician before undertaking any new exercise, diet, or supplement program.

AHA: Don’t turn to hormones. The AHA does not recommend hormonal therapy to treat or prevent heart disease.
LFA: In women with lupus and a history of blood clots, hormonal therapy is contraindicated due to the increased risk of thrombosis (blood clotting). Always consult your physicians before using any hormone therapies.

AHA: Do ask your physician about aspirin therapy, which has been shown to prevent strokes in women of all ages and to prevent heart attacks in women over 65.
LFA: Low dose aspirin may be used in young women with lupus due to their increased risks of cardiovascular disease, in addition to the increased clotting risk if they also have antiphospholipid antibodies.

AHA: Do make sure your diet includes fruits, vegetables, whole grains, and oily fish, like salmon, which are rich in omega-3 fatty acids.
LFA: These guidelines are suitable for people with lupus.

AHA: Don’t overdo the vitamin supplements -- specifically Vitamins E, C, A (beta-carotene), B6 and B12, and folic acid. The AHA suggests that these supplements have no effect on cardiovascular health, and some may even be harmful.
LFA: While folic acid may be prescribed for people with lupus taking methotrexate, you should consult your physician about taking any vitamin supplements.

AHA: Do get at least 30 minutes of moderately intense exercise daily. Try swimming laps or taking a brisk walk.
LFA: If muscle or joint pain make brisk walking or lap swimming too difficult, try a more moderate walk pace or a low-impact aquacise class.

AHA: Do limit alcohol to one drink a day, and sodium to 2.3 grams per day.
LFA: These guidelines are suitable for people with lupus. However, for people taking certain medications, such as methotrexate, it may not be advisable to have any alcohol due to the increased risk for liver injury caused by this medication.

AHA: Do stop smoking.
LFA: Smoking or using any tobacco product is one of the worst things you can chose to do when you have lupus.

Lupus Foundation of America Spring 09