Atherosclerosis in Children with SLE

Abstract

Research Article| May 01 2010 Atherosclerosis in Children with SLE AAP Grand Rounds (2010) 23 (5): 52. https://doi.org/10.1542/gr.23-5-52 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Atherosclerosis in Children with SLE. AAP Grand Rounds May 2010; 23 (5): 52. https://doi.org/10.1542/gr.23-5-52 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: atherosclerosis, carotid intima-media thickness, systemic lupus erythematosus Source: Huang Y-L, Chung H-T, Chang C-J, et al. Lymphopenia is a risk factor in the progression of carotid intima-media thickness in juvenile-onset systemic lupus erythematosus. Arthritis Rheum. 2009; 66(12): 3766– 3775; doi: https://doi.org/10.1002/art.25019Google Scholar Investigators from Taiwan carried out a prospective study of patients with juvenile systemic lupus erythematosus (SLE) to determine parameters associated with atherosclerosis. Eligible subjects fulfilled the 1982 American College of Rheumatology SLE criteria, had disease onset before 18 years of age, and were <28 years old at time of study. Increases in carotid intima-media wall thickness (IMT), assessed by carotid ultrasound, were used as a measure of atherosclerosis progression.1 Carotid IMT ultrasound was performed at study entry (baseline) and at six-month intervals, with a minimum total follow-up time of 1.5 years. Body mass index (BMI), blood pressure, lipid measurements, laboratory studies, clinical features, and medication use were monitored. Traditional risk factors associated with atherosclerosis such as hypertension, diabetes mellitus, dyslipidemia, a family history of premature cardiovascular disease, smoking, and obesity were examined. Control subjects included nursing student volunteers or healthy children examined for functional murmurs. Control subjects were excluded if they had a history of an autoimmune or other inflammatory disease, pregnancy, or were on lipid metabolism-altering medication. Control subjects had only one ultrasound and clinical evaluation. There were 76 SLE and 38 control subjects. Mean age of SLE patients at baseline was 15.0 ± 3.5 years, and mean disease duration 2.6 ± 2.5 years. SLE subjects were more likely to have hypertension, renal disease, and dyslipidemia. SLE subjects had significantly thicker IMT at baseline than controls (mean ± SD: 0.63 ± 0.08 mm vs 0.54 ± 0.06 mm; P<.001). There was no correlation of baseline IMT values with age, disease duration, disease activity, or current steroid dosage. In multivariate analysis, only lymphopenia at study entry and at diagnosis were significantly associated with IMT progression (P=.012 and P=.045, respectively). The authors conclude that lymphopenia is an independent risk factor for accelerated atherosclerosis. SLE patients are known to have markedly increased rates of cardiovascular disease, with female patients in their mid-30s to −40s having up to a 50-fold increased risk of myocardial infarction.2 This increased risk reflects both traditional atherosclerosis risk factors such as obesity, dyslipidemia, and hypertension, and inflammatory and immune issues specific to SLE. Children with SLE often have a more severe disease course than adult patients, and due to earlier disease onset, may be at even higher risk for long-term cardiovascular sequelae. Other pediatric studies have identified potential risk factors associated with a baseline increase in carotid IMT3 but this is the first to carry out serial IMT assessments enabling the authors to look for factors associated with carotid IMT progression. This is also the first SLE study to identify lymphopenia as a risk factor for IMT progression. Lymphopenia is a common disease manifestation of SLE. In this study, 67% of patients had... You do not currently have access to this content.