title: The vascular phenotype of children with systemic lupus erythematosus.
abstract: BACKGROUND
  The increased risk of cardiovascular disease (CVD) in adults with systemic lupus erythematosus (SLE) has been known since the 1970s, but studies in juvenile-onset SLE (JSLE) have reported conflicting results and more data are needed. The aim of this cross-sectional study was to establish the baseline risk of CVD in a cohort of UK patients with JSLE.
  
  
  METHODS
  Data were collected to establish disease duration, disease activity, medication use and activity levels, as well as demographic data, including family history of CVD. Vascular phenotype was established using well-validated measures of carotid intima media thickness (cIMT) and pulse wave velocity (PWV).
  
  
  RESULTS
  In total, 45 children (39 female; mean age 13.5 ± 2.9 years) with JSLE were recruited to the study. Of these, 24 had a history of biopsy-proven lupus nephritis and five had an estimated glomerular filtration rate of <90 ml/min/1.73 m(2). Comparison of these JSLE patients with healthy controls previously scanned at our hospital revealed that the cIMT value was significantly higher in the former (0.45 vs. 0.37 mm, respectively; p < 0.0001). This difference was associated with the use of antihypertensives (p = 0.04) and higher or lower doses of prednisolone (p < 0.0001). PWV was not significantly different in the patient and control group (5.27 vs. 5.34 m/s, respectively; p = 0.77). In the patient group, the mean body mass index percentile was 65.63 ± 28.8, and the median physical activity score was 1,773 (676-2,854) metabolic equivalents of task (METs). None of the patients admitted to cigarette smoking, and ten had a positive family history of cardiovascular disease (CVD).
  
  
  CONCLUSIONS
  This study shows that our patients with JSLE had increased cIMT without an increase in PWV, suggesting possible early adaptive changes in JSLE. Follow-up data are needed to determine whether these changes result in clinically significant CVD.
authors.affiliation: Department of Nephrology, The Royal Children's Hospital, Parkville, Victoria, 3052, Australia, Cathy.Quinlan@rch.org.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Quinlan
authors.forename: Jameela
authors.initials: J
authors.lastname: Kari
authors.forename: Clarissa
authors.initials: C
authors.lastname: Pilkington
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.forename: Rukshana
authors.initials: R
authors.lastname: Shroff
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
authors.forename: Kjell
authors.initials: K
authors.lastname: Tullus
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D010641:Phenotype; D063177:Pulse Wave Analysis; D012307:Risk Factors