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

Abstract

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.

Dyslipidemia in Pediatric Systemic Lupus Erythematosus: The Relationship with Disease Activity and Plasma Homocysteine and Cysteine Concentrations

“…A cohort study demonstrated an association between the use of CTCs and lipid profile changes in patients with juvenile SLE [27]. Another study verified that the prednisone dose affects the levels of LDL-c and total cholesterol independent of disease activity [33]. A possible explanation for the lack of an association between dyslipidemia and the use of medication in the present study may be due to the low doses of CTCs that were used.…”

Lipid Profiles in Systemic Lupus Erythematosus- An Update

“…10 Disease activity of SLE and lipid profile Dyslipoproteinemia of active disease consists of depressed HDL cholesterol with elevated very low density lipoprotein(VLDL) cholesterol and triglyceride (TG) levels. 11 Sarkissian T. et al study found that, active SLE patients had proatherogenic lipid profile 12 and also found that, at the time of diagnosis, the mean levels of total cholesterol, LDL cholesterol, and triglycerides were highest, whereas mean levels of HDL cholesterol were lowest. The percentage of patients with abnormal triglyceride value was highest at diagnosis, decreased at year one, and then remained relatively constant thereafter.…”

“…Low levels of HDL cholesterol were associated with active SLE, whereas the prednisolone dosage was associated with increased levels of HDL cholesterol. 12 The study done in our country found that control of disease activity in SLE was the most important factor in normalising the lipid profile.…”

“…The lowest mean HDL cholesterol levels were found at the time of diagnosis, and these values increased with time. 12 Kakati et al 4 . in their study measured fasting lipid profiles in 30 SLE patients.…”

Systemic lupus erythematosus in children and adolescents

“…Bekannt ist, dass die Arteriosklerose bereits im Kindesalter beginnt, die klinischen Zeichen aber erst viele Jahre später sichtbar werden. Arteriosklerotische Plaques und anomale Flussverhältnisse wurden bei jugendlichen SLE-Patienten bereits nach 2-5 Jahren nachgewiesen [23,25]. Die Ursache für das erhöhte Risiko liegt zum einen in der langdauernden Steroidtherapie, die zu Adipositas, arterieller Hypertonie, Hyperglykämie und Störung des Fettstoffwechsels führt, zum anderen prädispo-niert die Erkrankung selbst zur Arteriosklerose.…”