Cardiovascular disease is one of the leading complications of lupus. This presentation by Dr. Jim Oates outlines the causes and risk factors for the build-up of fats, cholesterol and other substances on arterial walls (known as atherosclerosis). Oates draws from recent research to show how uncontrolled cardiovascular disease can negatively impact the treatment of lupus.

What is atherosclerosis?

Atherosclerosis is a disease in which plaque builds up inside of your arteries. Plaque is a sticky substance made up of fat, cholesterol, calcium and other substances found in the blood. Over time, plaque hardens and narrows your arteries, which limits the flow of oxygen-rich blood to your body.

What causes atherosclerosis?

This disease is caused by inflammation in the endothelial cells that line the arteries. Inflammation signals these cells to:

• Call inflammatory cells to the artery wall,
• Encourage inflammatory cells to enter the artery wall, and 
• Encourage cells to take up cholesterol, which forms plaque.

What are some traditional risk factors?

• Smoking 
• Diabetes
• High blood pressure
• Central obesity
• Family history of ealy heart attacks
• Inactivity
• Saturated and trans fat intake
• High glycemic index foods

What are potential cardiac issues in people with SLE?

Individuals living with systemic lupus erythematosus (SLE) are at risk for strokes and heart attacks 4.8 to 9.8 times more than the general population. The risk of diabetes is 3 fold. These risk factors are often independent of traditional risk factors, such as family history, high blood pressure, cholesterol, sugar and body mass index.

What are associations with atherosclerosis in SLE?

• Longer duration of lupus
• More damage from lupus
• More prednisone use
• Less aggressive immune suppressing medication
• Less hydroxychloroquine (Plaquenil) use

What should I do about preventing heart attacks and strokes?

If you don't have an allergry or intolerance, take your hydroxychloroquine (Plaquenil). You should work with your doctor to "treat to target" to lower your lupus disease activity. And avoid long-term prednisone.

What is the best way to do all of the above?

Maintain an activity level of 30 minutes a day with a heart rate of less than 120. And, of course, eat a health diet.

What is the best diet?

• High fruit and vegetables (5 servings a day)
• Fish and poultry twice a week and sparing use of lean meats
• If it didn't have a mother or come out of the ground, you shouldn't eat it (i.e., fresh, not processed ingredients)
• Low in saturated and transfat (if fat is solid at room temperature, don't eat it)
• If you are salt sensitive, low salt (2-3 grams a day; a teaspoon is 6 grams)

What are some ways to exercise?

• Walk, bike, swim (20-30 minutes a day)
• Take the stairs
• Park far away
• Use a walking mower
• For short distances, bike or walk
• Take yoga, pilates, tai chi
• Play exercise video games -- using the Wii, for example
• Dance!

What are examples of calories used in 15 minutes?

• Sitting: 18
• Slow walk: 54
• Fast walk (3 mph): 72
• Biking (12 mph): 92
• Swimming (50 yards/minute): 118
• Jogging (5 mph): 167