title: Early determinants of atherosclerosis in paediatric systemic lupus erythematosus.
abstract: OBJECTIVE
  To assess traditional and non-traditional cardiovascular risk factors and to determine the prevalence and correlates of early vascular markers of atherosclerosis in paediatric systemic lupus erythematosus (pSLE).
  
  
  METHODS
  Fifty-four adolescents with pSLE had cardiovascular risk factor assessment, disease activity and vascular testing including carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), arterial stiffness measures, and myocardial perfusion studies.
  
  
  RESULTS
  The traditional risk factors of hypertension, elevated triglycerides, apolipoprotein B, haemoglobin A1c and insulin levels and non-traditional risk factors of elevated homocysteine and fibrinogen were present (all p<0.001). Some arterial stiffness measures, central pulse wave velocity and characteristic impedance were elevated (p<0.001), but CIMT, FMD and myocardial perfusion were normal. Cumulative prednisone dose correlated with total cholesterol (r=0.5790, p<0.001) and elevated LDL-C (r=0.4488, p=0.0012). Hydroxychloroquine treatment correlated negatively with total cholesterol (r=-0.4867, p=0.0002), LDL-C (r=-0.4805, p=0.0002) and apolipoprotein B (r=-0.4443, p=0.0011). In multivariate analysis LDL-C correlated with cumulative prednisone dose and negatively with hydroxychloroquine treatment (R2=0.40, p<0.001).
  
  
  CONCLUSIONS
  An increased burden of traditional and non-traditional risk factors and early evidence of insulin resistance and increased central arterial stiffness were present in paediatric SLE. Disease-specific and therapy-related factors are likely modifying these cardiovascular risk profiles warranting prospective longitudinal studies.
authors.affiliation: Divisions of Rheumatology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: C A
authors.initials: CA
authors.lastname: Boros
authors.forename: T J
authors.initials: TJ
authors.lastname: Bradley
authors.forename: M M H
authors.initials: MM
authors.lastname: Cheung
authors.forename: J M
authors.initials: JM
authors.lastname: Bargman
authors.forename: J L
authors.initials: JL
authors.lastname: Russell
authors.forename: B W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: K
authors.initials: K
authors.lastname: Adeli
authors.forename: J
authors.initials: J
authors.lastname: Hamilton
authors.forename: E D
authors.initials: ED
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D001055:Apolipoproteins B / Q000097:blood; D050197:Atherosclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D004548:Elasticity / Q000502:physiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D015995:Prevalence; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D001055:Apolipoproteins B; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human