5 Ways Lupus Can Hurt Your Heart

General Health & Wellness Heart & Vascular

August 12, 2025

Tags: Rheumatology , Heart Health , Heart Disease ,

Lupus, an autoimmune disease that causes inflammation throughout the body, is widely known for damaging the skin and joints. But less realized - but critical - is the damage lupus can do to organs like the heart.

"The major cause of death if you have lupus, is heart disease," said Marcia Johnson, MD, PhD, rheumatologist at Franciscan Health Lafayette East. "It's actually about 50 times higher for a woman aged 35 to 44 if they have lupus."

In fact, having lupus increases your risk of coronary artery disease and other heart conditions. But you can still take steps to help your heart's health.

A research review published in the journal Lupus in 2023 found the increased risk of stroke, heart attack and cardiovascular disease to be about two to three times higher in someone with lupus compared to the general population. A study published in Arthritis Care and Research in 2020 found that 18- to 39-year-olds with lupus had a higher incidence of a heart attack or stroke than 50- to 65-year-olds in the general population. A frequently cited 1997 study in the American Journal of Epidemiology estimated that women ages 35 to 44 were more than 50 times more likely to have a heart attack if they had lupus.

Lupus can also cause inflammation in different parts of the heart:

1. Coronary Artery Disease

Lupus increases your risk for heart disease, including coronary artery disease and atherosclerotic heart disease. Coronary artery disease happens when material builds up in the arteries and decreases blood flow to the heart. When blood flow to the heart is completely blocked, it causes a heart attack.

Lupus patients who have skin symptoms are 72% more likely to develop atherosclerotic heart disease, in which arteries become clogged and less flexible, according to a new study published recently in the journal JAMA Dermatology.

2. Pericarditis

Pericarditis is inflammation in the sac around the heart. Symptoms include chest pain and shortness of breath or pain with a deep breath.

"Pericarditis is an inflammation of a lining around the heart, and you could leak fluid from the inflammation," Dr. Johnson said. "You can actually get a pericardial effusion or fluid around your heart. If that is too large, your heart can't pump well, and that's incredibly serious. You'd end up in ICU. They feel that's seen in about 25% of lupus patients is what the literature says.

"It tends to cause chest pain as you might expect, which actually improves by leaning forward. And, ECG can show some changes that are kind of specific for it too. So it's something where people, if they're you know, feeling awful enough, they go to the emergency room where they would diagnose it."

3. Endocarditis

Endocarditis is inflammation in the heart walls and valves. It can cause clumps of material to build up on the heart valves, which may break off and form blood clots.

4. Myocarditis

Myocarditis is inflammation in the heart muscle. Symptoms can include chest pain, swelling, fatigue with exertion, or irregular heartbeat.

"That's rare, thank goodness," Dr. Johnson said. "It's actually where the heart muscle is inflamed. And obviously if that is severe, it can definitely impair the ability of your heart to pump. It can also affect the conducting system, the electrical system around the heart. And again, fortunately that is rarer, a lot rarer because it could be very serious."

5. Heart Valve Disease

"Another thing lupus can do, which usually again, rarer, is it can affect the heart valves where you can actually have growths on the valves, not infection," Dr. Johnson said. "But if you have that, you're at high risk for getting an infection affecting that, 'cause you kind of changed the structure of the valve. It's called Libman-Sacks endocarditis. And also there's a higher risk of, of stroke if those little vegetations, as it were, break off."

How Inflammation With Lupus Contributes To Heart Disease

"Inflammation of any sort, whether it is lupus or due to active rheumatoid arthritis or other diseases, does increase the risk of heart disease," Dr. Johnson said. "One theory is that might be related to damage to the blood vessels due the inflammation. Controlling the underlying cause can help reduce that risk."

Lowering Heart Disease Risk When You Have Lupus

Two key steps help you lower your risk of heart disease when you have lupus: Getting lupus in remission and keeping heart-healthy habits.

"The main thing is to get the lupus in remission if you can," Dr. Johnson said. "There's a drug called Plaquenil, hydroxychloroquine, classic lupus drug, which in some studies it's shown it decreases the risk of heart disease by 50%. And the other things you can do are the regular things you do if you have heart disease or concerned about it, you know, diet, exercise, monitoring cholesterol, not smoking."

Often your primary doctor and lupus doctor can help manage your risk, and sometimes a cardiologist can find out if you have heart problems related to lupus. If you have symptoms of heart problems you may need different kinds of tests, including: