Comparison of lipid levels at different points in the course of pediatric systemic lupus erythematosus and the effect of prednisone administration revealed that the association between the two is complex, a small retrospective study demonstrated.
“The significance of our findings should be put into the context of studies which have demonstrated that levels of LDL cholesterol and HDL cholesterol, and not levels of triglycerides or total cholesterol, are the lipids that are associated with the presence of fatty streaks and raised arterial lesions in the aorta as well as with increased carotid and femoral intima-media thickness and carotid plaque formation,” wrote the researchers, led by Talin Sarkissian of the division of rheumatology at the Hospital for Sick Children, Toronto. “Therefore, our findings have important implications when considering therapeutic interventions on pediatric patients with SLE” (Arthritis Rheum. 2006;54:1283–90).
The researchers obtained lipid measurements at diagnosis, and at 1, 2, and 3 years in 114 female and 25 male patients with pediatric systemic lupus erythematosus (SLE) who received care at the Hospital for Sick Children between October 1994 and April 2003. The researchers also obtained SLE Disease Activity Index scores and prednisone dosages at the same time periods. The mean patient age at the time of diagnosis was 14 years.
At the time of diagnosis, the mean levels of total cholesterol, LDL cholesterol, and triglycerides were highest, while the mean levels of HDL were lowest.
After diagnosis, “the mean total cholesterol levels decreased during year 1, then remained relatively constant, while the percentage of patients with abnormal total cholesterol values remained relatively constant,” the researchers wrote. The mean LDL cholesterol levels decreased during year 1 and then remained relatively constant during years 2 and 3, they reported.
When the researchers compared the lipid levels at different prednisone doses and disease activity levels, they observed that the changes in triglyceride levels were primarily associated with changes in disease activity.
Total cholesterol levels “were higher when patients were taking high-dose prednisone as compared with when they had active SLE but were taking low-dose prednisone, but were not higher than at the time of diagnosis of SLE,” the researchers wrote.
Mean HDL cholesterol levels “were significantly higher when patients were taking prednisone and the disease was inactive as compared with when patients were not taking prednisone but with active [SLE].”
Finally, mean LDL cholesterol levels “were significantly higher in patients with active disease who were taking prednisone as compared with the time when they had active disease but were not taking prednisone,” the wrote.
The researchers acknowledged that a major limitation of the study is its retrospective design but concluded that the findings suggest that “control of SLE appears to improve the levels of these important lipids.”