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Cumulative Prednisone Dose Among Important Risk Factors Identified For Atherosclerosis in Systemic Lupus Erythematosus Patients

Non-traditional predictors for atherosclerosis in patients with systemic lupus erythematosus (SLE) include prednisone cumulative intake, renal disease, and active disease at baseline, according to a new study.

Early clinical and subclinical atherosclerotic features have been demonstrated in SLE in several previous studies, and have been attributed to complex interactions between traditional risk factors and factors associated with the disease itself or its treatment. However, the role of each traditional and non-traditional risk factor in SLE is debated.

To evaluate risk factors for subclinical atherosclerosis in SLE, Andrea Doria, MD, of the University of Podova, Italy, and colleagues performed a prospective study of atherosclerosis in 78 SLE patients without overt atherosclerotic disease.

All patients were regularly monitored for clinical and laboratory parameters during a 5-year follow up period. At the end of follow up, patients underwent an echo colour Doppler (duplex) carotid ultrasound examination. Additionally, a blood sample was drawn at baseline and at end of follow up to test for immunological and inflammatory markers.

The investigators considered traditional risk factors for atherosclerosis including age, sex, total serum cholesterol, triglycerides, blood pressure, body mass index, diabetes mellitus, cigarette smoking, and family history of cardiovascular disease. Additionally, all prominent clinical and laboratory features specific to SLE were considered.

A thickened intima was observed in 28% of patients and plaque in 17%, both of which were associated with baseline renal disease (P = .030 and P = .012, respectively), baseline European Consensus Lupus Activity Measurement (ECLAM) score greater than 2 (P = .014 and P = .019, respectively), and azathioprine treatment (P = .031 and P = .006, respectively).

Furthermore, plaque was associated with cumulative prednisone intake greater than 40 g (P = .033).

Carotid abnormalities were observed in patients who were significantly older, had higher blood pressure and total serum cholesterol levels, and had taken a higher prednisone cumulative dosage than patients without lesions.

Among the non-traditional risk factors for atherosclerosis identified, cumulative prednisone dose appeared to be most important. Age and hypertension were confirmed as traditional risk factors.

Interestingly, immunological and inflammatory markers did not appear to have a role in predicting atherosclerosis in SLE.

Based on their findings, the researchers recommend that maximum effort be made to treat lupus glomerulonephritis adequately using the lowest possible dosage of corticosteroids associated with corticosteroid sparing therapy, and at the same time to manage renal complications (especially hypertension) as quickly as possible.


Ann Rheum Dis 2003 Nov;62:11:1071-7. "Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus"

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