TY - JOUR
T1 - Premature atherosclerosis in pediatric systemic lupus erythematosus
T2 - Risk factors for increased carotid intima-media thickness in the atherosclerosis prevention in pediatric lupus erythematosus cohort
AU - Schanberg, Laura E.
AU - Sandborg, Christy
AU - Barnhart, Huiman X.
AU - Ardoin, Stacy P.
AU - Yow, Eric
AU - Evans, Gregory W.
AU - Mieszkalski, Kelly L.
AU - Ilowite, Norman T.
AU - Eberhard, Anne
AU - Levy, Deborah M.
AU - Kimura, Yukiko
AU - Von Scheven, Emily
AU - Silverman, Earl
AU - Bowyer, Suzanne L.
AU - Punaro, Lynn
AU - Singer, Nora G.
AU - Sherry, David D.
AU - McCurdy, Deborah
AU - Klein-Gitelman, Marissa
AU - Wallace, Carol
AU - Silver, Richard
AU - Wagner-Weiner, Linda
AU - Higgins, Gloria C.
AU - Brunner, Hermine I.
AU - Jung, Lawrence
AU - Soep, Jennifer B.
AU - Reed, Ann
PY - 2009/5
Y1 - 2009/5
N2 - Objective. To evaluate risk factors for subclinical atherosclerosis in a population of patients with pediatric systemic lupus erythematosus (SLE). Methods. In a prospective multicenter study, a cohort of 221 patients underwent baseline measurements of carotid intima-media thickness (CIMT) as part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial. SLE disease measures, medications, and traditional risk factors for atherosclerosis were assessed. A standardized protocol was used to assess the thickness of the bilateral common carotid arteries and the mean maximal IMT of 12 segments. Univariable analysis identified potential associations with CIMT, which were examined in multivariable linear regression modeling. Results. Based on the mean-mean common or the mean-max CIMT as the dependent variable, univariable analysis showed significant associations of the following variables with increased CIMT: increasing age, longer SLE duration, minority status, higher body mass index (BMI), male sex, increased creatinine clearance, higher lipoprotein(a) level, proteinuria, azathioprine treatment, and prednisone dose. In multivariable modeling, both azathioprine use (P = 0.005 for the mean-mean model and P = 0.102 for the mean-max model) and male sex (P < 0.001) were associated with increases in the mean-max CIMT. A moderate dosage of prednisone (0.15-0.4 mg/kg/day) was associated with decreases in the mean-max CIMT (P = 0.024), while high-dose and low-dose prednisone were associated with increases in the mean-mean common CIMT (P = 0.021) and the mean-max CIMT (P = 0.064), respectively. BMI (P < 0.001) and creatinine clearance (P = 0.031) remained associated with increased mean-mean common CIMT, while increasing age (P < 0.001) and increasing lipoprotein(a) level (P = 0.005) were associated with increased mean-max CIMT. Conclusion. Traditional as well as nontraditional risk factors were associated with increased CIMT in this cohort of patients in the APPLE trial. Azathioprine treatment was associated with increased CIMT. The relationship between CIMT and prednisone dose may not be linear.
AB - Objective. To evaluate risk factors for subclinical atherosclerosis in a population of patients with pediatric systemic lupus erythematosus (SLE). Methods. In a prospective multicenter study, a cohort of 221 patients underwent baseline measurements of carotid intima-media thickness (CIMT) as part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial. SLE disease measures, medications, and traditional risk factors for atherosclerosis were assessed. A standardized protocol was used to assess the thickness of the bilateral common carotid arteries and the mean maximal IMT of 12 segments. Univariable analysis identified potential associations with CIMT, which were examined in multivariable linear regression modeling. Results. Based on the mean-mean common or the mean-max CIMT as the dependent variable, univariable analysis showed significant associations of the following variables with increased CIMT: increasing age, longer SLE duration, minority status, higher body mass index (BMI), male sex, increased creatinine clearance, higher lipoprotein(a) level, proteinuria, azathioprine treatment, and prednisone dose. In multivariable modeling, both azathioprine use (P = 0.005 for the mean-mean model and P = 0.102 for the mean-max model) and male sex (P < 0.001) were associated with increases in the mean-max CIMT. A moderate dosage of prednisone (0.15-0.4 mg/kg/day) was associated with decreases in the mean-max CIMT (P = 0.024), while high-dose and low-dose prednisone were associated with increases in the mean-mean common CIMT (P = 0.021) and the mean-max CIMT (P = 0.064), respectively. BMI (P < 0.001) and creatinine clearance (P = 0.031) remained associated with increased mean-mean common CIMT, while increasing age (P < 0.001) and increasing lipoprotein(a) level (P = 0.005) were associated with increased mean-max CIMT. Conclusion. Traditional as well as nontraditional risk factors were associated with increased CIMT in this cohort of patients in the APPLE trial. Azathioprine treatment was associated with increased CIMT. The relationship between CIMT and prednisone dose may not be linear.
UR - http://www.scopus.com/inward/record.url?scp=66049159848&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=66049159848&partnerID=8YFLogxK
U2 - 10.1002/art.24469
DO - 10.1002/art.24469
M3 - Article
C2 - 19404953
AN - SCOPUS:66049159848
SN - 0004-3591
VL - 60
SP - 1496
EP - 1507
JO - Arthritis and Rheumatism
JF - Arthritis and Rheumatism
IS - 5
ER -