A Patient Asks: Lupus & Cholesterol

LSI received the following question. Medical Advisory Board members facilitate answers to these questions. If you have a question, please forward it to [email protected] or call 312-542-0002.

Thanks to Dr. Shilpa Arora & Dr. Meenakshi Jolly for providing the answer to this patient’s question.

Question: I would like to know how lupus might cause your cholesterol levels to be high. Any information would be greatly appreciated.

Answer: Lupus patients in spite of their young age are at higher risk of cardiovascular diseases (such as heart attack and stroke). This is because of presence of traditional risk factors (high blood pressure i.e. hypertension and high cholesterol levels i.e. dyslipidemia) along with accelerated atherosclerosis (meaning plaque formation in blood vessels) due to oxidative stress and damage from chronic inflammation driven by active lupus.

The abnormal cholesterol levels are such that the bad cholesterol (mainly LDL and others VLDL and triglyceride) are higher and good cholesterol (HDL) is lower in lupus patients. These are again due to the effects of inflammation from the disease which affects the metabolism of these lipids (how they are processed) in the body. Patients whose lupus is active have higher chances of abnormal cholesterol levels as above in comparison to those with controlled (quiet) disease.

Other things which affect cholesterol levels are steroids especially in high doses which increase the cholesterol levels especially that of the bad cholesterol.

Hydroxychloroquine (Plaquenil) on the other hand has a beneficial role and increases the good cholesterol while decreasing bad cholesterol.

So in nutshell besides eating healthy, maintaining a balanced weight, exercising regularly; control of lupus disease activity, lowering of steroids and being on hydroxychloroquine are some things to do to control the cholesterol levels in lupus patients. Sometimes when the cholesterol levels are very high we also consider starting them on specific medications such as statins (atorvastatin etc) which may often be done by PCPs or cardiologists though.

Dr. Shilpa Arora