The frequency of high/moderate lipoprotein risk factor for coronary artery disease is significant in juvenile-onset systemic lupus erythematosus

Abstract

To determine the prevalence of dyslipoproteinemia on a large juvenile systemic lupus erythematosus (jSLE) cohort, we selected 40 patients after rigorous exclusion criteria. Lipoprotein levels were determinated after 12 hours fast and risk levels for CAD were defined by standards of the Brazilian Guidelines for dyslipoproteinemia according to US-NCEP. All individuals were under steroid therapy and chloroquine and 43% had active disease. Thirty patients (75%) had high-risk levels for CAD (23 isolated low HDL, while in seven subjects low HDL was associated to high TG in four, high LDL in one, high TG/LDL in one and high TC/LDL in one). Remarkably, overall analysis revealed that 85% patients were included in high/medium risk levels group (29% for TC, 29% for LDL, 88% for HDL, and 18% for TG) and these disturbances occured mainly in the first four years of disease. Unexpectedly, one-third of the patients presented two or more high/medium lipoprotein risk factors. Independently, active jSLE was associated to TG (OR = 3.2; P < 0.001) and had a tendency towards reduction on HDL (OR = 8.5; P = 0.056). Considering improvements on jSLE outcome, the increased frequency of high/medium lipoprotein risk levels for CAD reinforces the need of prevention measures in order to minimize deleterious effects of this disturbance.

Review: Management of dyslipidemia in children and adolescents with systemic lupus erythematosus

“…Several cross-sectional studies of children and adolescents with SLE have identified rates of dyslipidemia ranging from 50% to 85% (see Table 2). 5,15,24 These rates are comparable to studies in adult SLE. 25 Interpretation of cross-sectional data is complicated by differing definitions of dyslipidemia and inclusion of patients with varying levels of disease activity, medication use and differing prevalence of nephrotic syndrome.…”

Risk factors associated with the death of patients hospitalized for juvenile systemic lupus erythematosus

“…In contrast, 1 patient with aspergillosis and another with miliary tuberculosis did not receive proper treatment for their respective infections. Interestingly, atheroma plaques were observed at autopsy in 2 cases, both associated with dyslipidemia, i.e., elevation of low-density cholesterol fraction and decrease of the high-density fraction, according to the literature (16). Neither patient had received antimalarial drugs.…”

“…Some investigators have described worse prognostic factors in JSLE such as male sex (6,7), disease activity (8), active chronic disease (9), presence of cumulative disease damage (10,11), arterial hypertension, proteinuria, acute renal failure (ARF) (4), lupus nephritis (12), neuropsychiatric involvement (13), antiphospholipid antibody syndrome (14), anti-DNA antibody increase (1), acute thrombocytopenia (10), infection (15), immunosuppressive treatment (10), and atherosclerosis (16). Most of the morbiditymortality studies on JSLE have evaluated worse prognostic factors and survival curves in patients from one or more Services of Pediatric Rheumatology, including outpatients and inpatients (8,17).…”

The potential role of Colchicine in preventing coronary vascular disease in childhood‐onset lupus: a new view on an old drug

“…Atherosclerosis is known to begin in adolescence even in the absence of SLE [26], yet patients with childhoodonset lupus experience accelerated atherosclerosis and early CVD [1,2,8]. Dyslipidemia is present in 63-85 % of children and adolescents with lupus even at initial diagnosis [27,28], compared to approximately 20 % of the general pediatric population [29]. Despite premature atherosclerosis, clinical CVD manifested by MI and angina pectoris in pediatric patients with lupus is rare [4,30,31].…”