P.014 Vascular Markers of Premature Atherosclerosis in Paediatric Systemic Lupus Erythematosus and Disease, Therapy, Metabolic and Inflammatory Correlates

Abstract

Purpose

Controversy exists as to whether the dyslipidemia and premature atherosclerosis which occurs in Systemic Lupus Erythematosus (SLE) is more due to disease activity or the therapy. We sought to determine the presence and correlates of vascular markers of premature atherosclerosis in paediatric SLE.

Methods

Vascular assessment included: carotid intima-media thickness and brachial artery reactivity using vascular ultrasound; peripheral pulse wave velocity (PWV) using photoplethysmography; central PWV, arterial stiffness and impedance indices using an Echo-Doppler method. These vascular indices were converted to z-scores from normal population data, and tested for normality with single sample t-tests. Augmentation index and PWV, using applanation tonometry, were only assessed in the latter half of the cohort. Disease activity scores, disease duration, cumulative prednisone dose, other medication use and fasting lipid, glycemic and inflammatory profiles were also determined and Pearson correlations performed.

Results

Seventy paediatric SLE were assessed (median age 15.7 [7.3–18.7] years and diseased duration 1.4 [0.1–11.0] years, 80% females). The mean z-score adjusted data was significantly increased from normal for central PWV (+1.1, p < 0.0001), input (+0.3, p <0.04) and characteristic impedance (+0.8, p < 0.0001). Correlations were found between aortic elastic modulus and higher fasting glucose (R 0.34, p < 0.007), and between stiffness index and homocysteine levels (R 0.38; p < 0.008).

Conclusions

In treated paediatric SLE of relatively short duration, dyslipidemia, abnormal glycemic and inflammatory profiles were relatively common. Some stiffness measures were increased and others correlated with known atherosclerotic risk factors. These patients warrant long-term monitoring of vascular function and traditional and non-traditional risk factors.