RESEARCH - Recent steroid use and recent disease activity: independent determinants of coronary heart disease risk factors in SLE?

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Arthritis Rheum. 2008 Jan 31;59(2):169-175 [Epub ahead of print]

Recent corticosteroid use and recent disease activity: Independent

determinants of coronary heart disease risk factors in systemic lupus

erythematosus?

Karp I, Abrahamowicz M, Fortin PR, Pilote L, Neville C, Pineau CA, Esdaile JM.

University of Montreal, the Montreal University Health Center, and

McGill University, Montreal, Quebec, Canada.

OBJECTIVE: Systemic lupus erythematosus (SLE) is characterized by a

markedly elevated risk for coronary heart disease (CHD), the exact

pathogenesis of which is unknown. In particular, the causal roles of

corticosteroid therapy and SLE disease activity, and whether their

putative effects are mediated through conventional risk factors,

remain unclear. METHODS: Data abstracted retrospectively from the

charts at 11,359 clinic visits for 310 patients with SLE to the

Montreal General Hospital were used to investigate the associations of

recent corticosteroid dose and recent Systemic Lupus Erythematosus

Disease Activity Index (SLEDAI) score with 8 CHD risk factors (total

serum cholesterol, high-density lipoprotein [HDL] cholesterol,

low-density lipoprotein cholesterol, apolipoprotein B [Apo B],

triglycerides, systolic blood pressure [bP], body mass index, and

blood glucose) and the aggregate estimate of 2-year CHD risk. Separate

multivariable linear regression models estimated the mutually-adjusted

effects of average daily corticosteroid dose and average SLEDAI score

within the past year on the current level of each risk factor while

adjusting for age, sex, cumulative damage score, disease duration,

and, where appropriate, use of relevant medications. RESULTS: Higher

past-year corticosteroid dose was independently associated with

significantly higher overall 2-year CHD risk and with higher levels of

all 8 individual risk factors. Higher past-year lupus disease activity

was independently associated with higher overall 2-year CHD risk,

lower HDL cholesterol, and higher values of systolic BP, Apo B,

triglycerides, and blood glucose. CONCLUSION: In SLE, both recent use

of corticosteroids and recent lupus activity are independently

associated with higher values of several well-recognized CHD risk

factors and overall 2-year CHD risk.

PMID: 18240259

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=182402\

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