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Stories for Reprint
Certain Lupus Patients Should Get Screened for Heart Trouble Yearly
By Katerina Pesheva
People who have a form of lupus called systemic lupus erythematosus (SLE) should be screened for cardiovascular disease and evaluated regularly after that - perhaps once a year - a new report suggests. The recommendations came out of the annual European Lupus Meeting and were published in Rheumatology News, the trade journal of U.S. rheumatologists.
Doctors have known for years that systemic lupus can affect internal organs, including the heart. But this is the first time physicians are recommending routine screening for cardiovascular disease among patients, even those without symptoms. People with lupus who do not have symptoms should be screened annually. People who have more than two risk factors (including diabetes, high blood pressure, smoking, family history, high cholesterol) should be evaluated further, perhaps by undergoing an exercise stress test, the guidelines suggest.
"[People with SLE] should be treated like patients with diabetes and, if they have five or more years of active disease, a strong family history of coronary artery disease or two or more cardiovascular risk factors, they should have an initial stress test and repeated every two-three years," said Dr. Stephen Paget, professor of medicine and rheumatic diseases at Cornell University.
An echocardiogram (an ultrasound picture of the heart) should be done once a year even in people without symptoms to evaluate valves and other structures of the heart.
People with SLE should be monitored by their primary physician in tandem with a rheumatologist.
SLE patients should be aware of the classic heart disease symptoms, including chest pain, shortness of breath and ankle swelling, and contact their doctor without delay should such symptoms develop, Paget said.
People with SLE are also at high risk for strokes and mini-strokes called transient ischemic attacks (TIA), said Dr. Jane Salmon, director of the Lupus Registry at New York City's Hospital for Special Surgery and professor of medicine at Cornell University. Therefore, people with SLE should be aware of stroke symptoms as well, which among others include numbness on one side of the body, severe and sudden headache, slurred speech, blurred vision and mental confusion. Salmon says that people with SLE who have more than two risk factors for cardiovascular disease might benefit from a test called carotid ultrasound, which provides an image of the carotid artery, a vessel located in the neck that supplies blood flow to the brain.
One possible explanation for the early-onset heart disease in people with SLE is disease-related inflammation that overflows to blood vessels, leading to premature hardening and narrowing of the heart's arteries and accumulation of plaque, Paget said.
Young women with lupus have an incidence of heart disease only slightly lower than this of middle-aged and older men with diabetes and this of middle-aged men who already have suffered a heart attack, European researchers found.
Classic risk factors increase the risk of heart disease among both non-lupus and lupus patients alike, however, lupus patients are affected even by theses risk factors than people without lupus, European researchers said.
While a SLE diagnosis does not necessarily mean an impending heart attack or heart failure, people with lupus should be aware of their increased risk. A daily baby aspirin is probably a good idea, as well as cholesterol-lowering medication for those with high cholesterol, Paget said.
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