Heart Attacks, Strokes, and Blood Clots in Lupus

People with lupus face a significantly higher risk of cardiovascular events, including heart attacks, strokes, and blood clots, compared to the general population. These complications often result from the inflammation and immune system abnormalities that define lupus. Additionally, lupus-related conditions like antiphospholipid syndrome (APS) can further increase clotting risks. Chapter 21 of The Lupus Encyclopedia explores these serious concerns in detail.

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Cardiovascular (CV) events include prob­lems with the heart and blood vessels. Cardio-­ refers to the heart, and “-­vascular” refers to the body’s blood vessels. CV events are a top cause of death in SLE patients in the United States. More than one out of every three ­people with SLE die from a CV event.

Chapter 11 discussed how SLE could attack the heart and blood vessels, causing inflammation and damage. This chapter focuses on how people with lupus develop heart and blood vessel prob­lems for other reasons as well.

The Lupus Encyclopedia (2nd ed.), p. 409

Understanding the Types of Cardiovascular Events in Lupus

People with lupus have a much higher risk of cardiovascular disease than the general population. In fact, The Lupus Encyclopedia states that “CV events such as heart attacks, strokes, and blood clots are among the most common causes of death in SLE.” Chapter 21, page 430.

The book also explains that “accelerated arteriosclerosis occurs in SLE, meaning it occurs faster and at earlier ages.” Chapter 21, page 430. Consequently, our lupus patients must pay close attention to heart and blood vessel health.

Heart Attacks (Myocardial Infarctions)

Heart attacks happen when blood flow to the heart becomes blocked. Lupus inflammation damages blood vessels and increases plaque formation. According to The Lupus Encyclopedia, lupus inflammation can create “proinflammatory and oxidized HDL that can cause heart attacks and strokes.” Chapter 21, page 430.

Common symptoms include:

• Chest pressure or pain
• Shortness of breath
• Nausea
• Jaw or arm pain
• Sudden sweating
• Extreme fatigue

However, lupus patients sometimes experience unusual symptoms. Women with lupus may notice fatigue, indigestion, or upper back pain instead of classic chest pain.

Several lupus-related factors increase heart attack risk. The book lists “diabetes, obesity, HBP, abnormal cholesterol levels, lupus inflammation of blood vessels, lupus nephritis, antiphospholipid antibodies, high homocysteine levels, lack of exercise, steroids, and smoking.” Chapter 21, page 430.

Strokes (Cerebrovascular Accidents)

A stroke occurs when blood flow to part of the brain stops. Lupus increases stroke risk through inflammation, blood clots, and accelerated atherosclerosis.

The book explains that platelets “play an essential role in forming blood clots that cause strokes and heart attacks.” Chapter 21, page 426.

Stroke symptoms often appear suddenly. Warning signs include:

• Facial drooping
• Weakness on one side
• Slurred speech
• Vision changes
• Confusion
• Severe headache

Immediate treatment matters because brain tissue can die within minutes. Therefore, anyone with stroke symptoms should call emergency services immediately.

Long-term effects vary widely. Some people recover fully, while others develop speech problems, weakness, or memory issues.

Blood Clots (Thrombosis)

Blood clots commonly affect lupus patients, especially those with antiphospholipid antibodies. Clots may develop in veins or arteries.

Deep vein thrombosis usually affects the legs. Symptoms include swelling, redness, warmth, and pain. Pulmonary embolism occurs when a clot travels to the lungs. This can cause chest pain, rapid heartbeat, shortness of breath, and low oxygen levels.

The book notes that hydroxychloroquine “decreases blood clots, heart attacks, strokes, and death from CV events.” Chapter 21, page 430. Consequently, many rheumatologists strongly encourage lupus patients to remain on hydroxychloroquine unless contraindications exist.

What Is Antiphospholipid Syndrome (APS)?

Antiphospholipid syndrome is an autoimmune clotting disorder that often occurs alongside lupus. APS causes the immune system to produce abnormal antibodies that increase clotting risk.

The encyclopedia explains that antiphospholipid antibodies “play a role in blood clots and other CV events.” Chapter 21, page 429.

Testing for Antiphospholipid Antibodies

Doctors usually test for:

• Lupus anticoagulant
• Anticardiolipin antibodies
• Beta-2 glycoprotein I antibodies

Positive results may require repeat testing because temporary infections can sometimes affect antibody levels.

APS and Recurrent Clotting Events

Some patients experience repeated clots or pregnancy complications. Therefore, early diagnosis becomes very important. Many APS patients require lifelong anticoagulation therapy.

Diagnosis and Monitoring

Doctors use blood tests, imaging studies, and cardiovascular risk assessments to monitor lupus patients.

Blood Tests and Antibody Screening

Common laboratory tests include:

• Cholesterol panels
• Blood sugar testing
• Antiphospholipid antibodies
• Inflammatory markers
• Kidney function tests

The encyclopedia recommends regular monitoring because lupus patients should “follow up regularly with a primary care provider or cardiologist to check and treat CV risk factors.” Chapter 21, page 430.

Imaging for Heart and Brain Involvement

Doctors may order:

• Echocardiograms
• CT scans
• MRI studies
• Ultrasounds
• Coronary artery calcium scans

These tests help identify artery disease or clotting complications early.

Clotting Risk Assessment

Healthcare providers also review smoking history, steroid use, exercise habits, blood pressure, and family history.

Treatment and Prevention Strategies

Preventing cardiovascular disease requires a combination of medications and healthy lifestyle choices.

Anticoagulant Medications

Low-dose aspirin often helps reduce clotting risk. The encyclopedia states that “taking aspirin in small doses, such as 81 mg a day, can help prevent CV events.” Chapter 21, page 426.

Moreover, studies showed that patients taking both hydroxychloroquine and aspirin had fewer cardiovascular events than those taking either medication alone. Chapter 21, page 426.

Some patients also need stronger blood thinners like warfarin.

Managing Traditional Cardiovascular Risk Factors

Lifestyle changes remain essential. The encyclopedia recommends “a diet low in fat and cholesterol while high in omega-3 fatty acids, fiber, whole grains, fruits, and vegetables.” Chapter 21, page 427.

Recommended eating plans include:

• Mediterranean diet
• DASH diet
• Plant-forward diets

Exercise also plays a major role. The book states that “regular exercise has many health benefits beyond preventing CV disease.” Chapter 21, page 428.

Role of Hydroxychloroquine in Clot Prevention

Hydroxychloroquine offers important cardiovascular protection. According to the encyclopedia, antimalarials lower infection risk and reduce lupus activity. Additionally, hydroxychloroquine decreases cholesterol and blood clot risk.

You can learn more at Hydroxychloroquine and lupus treatment.

Lifestyle Tips for Heart and Vascular Health

Daily habits strongly influence cardiovascular outcomes in lupus.

Diet and Exercise Recommendations

The encyclopedia encourages regular aerobic activity because it “helps decrease weight and BP, control glucose, and elevate HDL.” Chapter 21, page 428.

Healthy eating patterns also reduce inflammation and cholesterol.

Smoking Cessation and Blood Pressure Control

Smoking greatly increases cardiovascular risk. Fortunately, quitting helps quickly. The book reports that after quitting smoking, people can eventually reach “the same risk for heart disease as if they had never smoked.” Chapter 21, page 428.

Blood pressure control also matters. The encyclopedia advises patients to “keep your BP below 120/80” and monitor readings regularly at home. Chapter 21, page 430.

Monitoring Cholesterol and Blood Sugar

Many lupus patients benefit from statin therapy. The encyclopedia notes that “those lupus patients who took a statin had fewer heart attacks.” Chapter 21, page 430.

Doctors should also monitor diabetes closely because high blood sugar accelerates artery damage.

When to Seek Immediate Medical Help

Fast treatment saves lives during cardiovascular emergencies.

Seek emergency care immediately for:

• Chest pain or pressure
• Sudden weakness
• Difficulty speaking
• Severe shortness of breath
• Sudden leg swelling
• Rapid heartbeat
• Fainting

Pulmonary embolism, stroke, and heart attack symptoms require urgent evaluation. Therefore, patients and families should learn warning signs before emergencies happen.

Education also empowers patients to act quickly. Recognizing symptoms early can prevent permanent disability and improve survival.

For more in-depth information on Heart Attacks, Strokes, and Blood Clots in Lupus:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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