Risk factors for coronary heart disease in women with systemic lupus erythematosus: The Toronto Risk Factor Study

Objective. To determine the prevalence of lipid abnormalities at different times and to determine the influence of both the disease and corticosteroid therapy on lipid abnormalities in pediatric patients with systemic lupus erythematosus (SLE).Methods. Lipid measurements were obtained in an inception cohort of 139 pediatric patients with SLE (114 females). Fasting levels of total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol, and highdensity lipoprotein (HDL) cholesterol in the SLE patients were compared with those in age-and sex-matched control subjects. Disease activity levels and medication dosages were obtained at the time of lipid measurements.Results. At the time of diagnosis, the mean levels of total cholesterol, LDL cholesterol, and triglycerides were highest, whereas the mean levels of HDL cholesterol were lowest. The percentage of patients with abnormal triglyceride values was highest at diagnosis, decreased at year 1, and then remained relatively constant thereafter. The mean total cholesterol and LDL cholesterol levels decreased at year 1 as compared with the time of diagnosis and then remained relatively constant. The lowest mean HDL cholesterol levels were found at the time of diagnosis, and these values rose with time. Comparison of lipid levels at different prednisone dosages and disease activity levels revealed that changes in triglyceride levels were mainly associated with changes in disease activity, changes in both total cholesterol and LDL cholesterol levels were associated with changes in the prednisone dosage and not disease activity, and low levels of HDL cholesterol were associated with active SLE, whereas the prednisone dosage was associated with increased levels of HDL cholesterol.Conclusion. Factors intrinsic to SLE appear to alter lipid levels. Control of SLE may be the most important factor in improving abnormal lipid profiles, and paradoxically, prednisone therapy may improve abnormal lipid levels.

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confidence: 77%

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confidence: 99%

The complex nature of the interaction between disease activity and therapy on the lipid profile in patients with pediatric systemic lupus erythematosus

Sarkissian¹,

Beyenne²,

Feldman³

et al. 2006

“…Despite a high level of scientific interest in blood rheology and cardiovascular disease in the general population, little work has focused on the role of rheologic variables in lupus, a disease characterized by premature atherothrombotic events (6,7,34,35). Because traditional risk factors do not fully explain the high rate of atherosclerotic disease in patients with SLE, nontraditional risk factors warrant greater scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Whole blood viscosity and arterial thrombotic events in patients with systemic lupus erythematosus

Booth¹,

Chohan²,

Curran³

et al. 2007

Objective. To determine if whole blood viscosity (WBV), a rheologic variable contributing to risk of myocardial infarction and stroke in the general population, is elevated in patients with systemic lupus erythematosus (SLE), particularly SLE patients with a history of thrombotic or atherothrombotic events. Because the high rates of arterial and venous thrombosis in lupus cannot be explained by traditional risk factors, elevated WBV may be an easily measurable nontraditional risk factor to identify SLE patients at high risk for thrombotic events. Methods. Sixty SLE patients (30 with a history of a thrombotic event) and 20 matched controls were recruited into the study. The thrombosis group was further subdivided into an arterial thrombosis group (n ‫؍‬ 17). WBV values were determined at 9 different shear rates (1, 2, 5, 10, 50, 100, 150, 300, and 1,000 seconds ؊1 ). WBV was then compared between groups by repeated-measures analysis of variance. Results. SLE patients with a history of arterial events had significantly elevated WBV relative to either controls (P ‫؍‬ 0.022) or SLE patients without arterial events (P ‫؍‬ 0.014). WBV in the total SLE group did not differ from controls. Differences in WBV were most prominent at lower shear rates (1, 2, 5, 10, 50, and 100 seconds ؊1 ). Anticoagulation, prednisone dose, and antiphospholipid antibodies did not significantly impact WBV. Conclusion. Our study demonstrated that WBV is selectively elevated in patients with SLE with a history of arterial events. Although this association is striking, longitudinal studies are needed to assess the positive predictive value of WBV for atherothrombotic events in SLE.

“…Accelerated atherosclerosis in particular is an important cause of premature morbidity and mortality, and the optimal way to prevent it is unknown. Although aggressive treatment of cardiac risk factors in patients with SLE is advocated (1)(2)(3)(4)(5), none of the prevention regimens or strategies have been critically evaluated. Clinical trials with the potential for important therapeutic benefit in the prevention of SLErelated atherosclerosis are therefore of paramount importance.…”

Section: Introductionmentioning

confidence: 99%

Factors determining participation in prevention trials among systemic lupus erythematosus patients: a qualitative study

Costenbader

Brome

Blanch

et al. 2007

Objective. A feasibility study for a trial of strategies for the prevention of atherosclerosis in patients with systemic lupus erythematosus (SLE) was stopped because of inadequate recruitment. There is little understanding of the factors influencing patients' decisions about participation in prevention trials. Our goal was to determine factors that patients with SLE consider in deciding about participating in prevention trials, to uncover concerns about SLE trials, and to investigate how study design and purpose affect participation decisions. Methods. We conducted focus groups with trial participants (n ‫؍‬ 13), trial nonparticipants (n ‫؍‬ 8), and a group of patients with diabetes (n ‫؍‬ 9). We conducted telephone interviews with SLE patients who refused participation in the trial and the focus groups (n ‫؍‬ 10). A trained facilitator elicited factors influencing participation decisions. Transcripts were coded and grouped into themes using grounded theory. Results. Demographic characteristics of the groups were similar. Seven factors emerged as important in decision making: current health status, study design, physician involvement, personal benefit, altruism, time, and incentives. These factors were considered by individuals who elected to participate and those who did not, but weighed differently. Among the trial participants, good health status, encouragement from one's physician, and desires to learn and to contribute stimulated participation. Reasons for nonparticipation included current health status, medication and randomization concerns, and personal factors. Conclusion. We observed that similar factors were weighed differently by participants and nonparticipants. Our results suggest that strategies such as health education, enlistment of personal physicians, and limitation of time requirements may enhance recruitment of patients with SLE into clinical prevention trials.