Laboratory markers of cardiovascular risk in pediatri SLE

The APPLE baseline cohort

S. P. Ardoin, L. E. Schanberg, C. Sandborg, E. Yow, H. X. Barnhart, K. L. Mieszkalski, N. T. Ilowite, E. Von Scheven, A. Eberhard, D. M. Levy, Y. Kimura, E. Silverman, S. L. Bowyer, L. Punaro, N. G. Singer, D. D. Sherry, D. McCurdy, M. Klein-Gitelman, C. Wallace, R. Silver & 7 others L. Wagner-Weiner, G. C. Higgins, H. I. Brunner, L. K. Jung, L. Imundo, J. B. Soep, A. M. Reed

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

As part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) Trial, a prospective multicenter cohort of 221 children and adolescents with systemic lupus erythematosus (SLE) (mean age 15.7 years, 83% female) underwent baseline measurement of markers of cardiovascular risk, including fasting levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), lipoprotein A (Lpa), homocysteine and high-sensitivity C-reactive protein (hs-CRP). A cross-sectional analysis of the baseline laboratory values and clinical characteristics of this cohort was performed. Univariable relationships between the cardiovascular markers of interest and clinical variables were assessed, followed by multivariable linear regression modeling. Mean levels of LDL, HDL, Lpa, TG, hs-CRP and homocysteine were in the normal or borderline ranges. In multivariable analysis, increased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), prednisone dose, and hypertension (HTN) were independently associated with higher LDL levels. Higher hs-CRP and creatinine clearance were independently related to lower HDL levels. Higher body mass index (BMI), prednisone dose, and homocysteine levels were independently associated with higher TG levels. Only Hispanic or non-White status predicted higher Lpa levels. Proteinuria, higher TG and lower creatinine clearance were independently associated with higher homocysteine levels, while use of multivitamin with folate predicted lower homocysteine levels. Higher BMI, lower HDL, and longer SLE disease duration, but not SLEDAI, were independently associated with higher hs-CRP levels. The R2 for these models ranged from 7% to 23%. SLE disease activity as measured by the SLEDAI was associated only with higher LDL levels and not with hs-CRP. Markers of renal injury (HTN, proteinuria, and creatinine clearance) were independently associated with levels of LDL, HDL, and homocysteine, highlighting the importance of renal status in the cardiovascular health of children and adolescents with SLE. Future longitudinal analysis of the APPLE cohort is needed to further examine these relationships.

Original languageEnglish (US)
Pages (from-to)1315-1325
Number of pages11
JournalLupus
Volume19
Issue number11
DOIs
StatePublished - Oct 2010

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HDL Lipoproteins
Systemic Lupus Erythematosus
Homocysteine
Atherosclerosis
Biomarkers
Pediatrics
C-Reactive Protein
LDL Lipoproteins
Lipoproteins
Creatinine
Triglycerides
Prednisone
Proteinuria
Body Mass Index
Renal Hypertension
Hispanic Americans
Folic Acid
Linear Models
Fasting
Cross-Sectional Studies

Keywords

  • atherosclerosis
  • cardiovascular
  • lipid
  • pediatric
  • SLE
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

Cite this

Ardoin, S. P., Schanberg, L. E., Sandborg, C., Yow, E., Barnhart, H. X., Mieszkalski, K. L., ... Reed, A. M. (2010). Laboratory markers of cardiovascular risk in pediatri SLE: The APPLE baseline cohort. Lupus, 19(11), 1315-1325. https://doi.org/10.1177/0961203310373937

Laboratory markers of cardiovascular risk in pediatri SLE : The APPLE baseline cohort. / Ardoin, S. P.; Schanberg, L. E.; Sandborg, C.; Yow, E.; Barnhart, H. X.; Mieszkalski, K. L.; Ilowite, N. T.; Von Scheven, E.; Eberhard, A.; Levy, D. M.; Kimura, Y.; Silverman, E.; Bowyer, S. L.; Punaro, L.; Singer, N. G.; Sherry, D. D.; McCurdy, D.; Klein-Gitelman, M.; Wallace, C.; Silver, R.; Wagner-Weiner, L.; Higgins, G. C.; Brunner, H. I.; Jung, L. K.; Imundo, L.; Soep, J. B.; Reed, A. M.

In: Lupus, Vol. 19, No. 11, 10.2010, p. 1315-1325.

Research output: Contribution to journalArticle

Ardoin, SP, Schanberg, LE, Sandborg, C, Yow, E, Barnhart, HX, Mieszkalski, KL, Ilowite, NT, Von Scheven, E, Eberhard, A, Levy, DM, Kimura, Y, Silverman, E, Bowyer, SL, Punaro, L, Singer, NG, Sherry, DD, McCurdy, D, Klein-Gitelman, M, Wallace, C, Silver, R, Wagner-Weiner, L, Higgins, GC, Brunner, HI, Jung, LK, Imundo, L, Soep, JB & Reed, AM 2010, 'Laboratory markers of cardiovascular risk in pediatri SLE: The APPLE baseline cohort', Lupus, vol. 19, no. 11, pp. 1315-1325. https://doi.org/10.1177/0961203310373937
Ardoin SP, Schanberg LE, Sandborg C, Yow E, Barnhart HX, Mieszkalski KL et al. Laboratory markers of cardiovascular risk in pediatri SLE: The APPLE baseline cohort. Lupus. 2010 Oct;19(11):1315-1325. https://doi.org/10.1177/0961203310373937
Ardoin, S. P. ; Schanberg, L. E. ; Sandborg, C. ; Yow, E. ; Barnhart, H. X. ; Mieszkalski, K. L. ; Ilowite, N. T. ; Von Scheven, E. ; Eberhard, A. ; Levy, D. M. ; Kimura, Y. ; Silverman, E. ; Bowyer, S. L. ; Punaro, L. ; Singer, N. G. ; Sherry, D. D. ; McCurdy, D. ; Klein-Gitelman, M. ; Wallace, C. ; Silver, R. ; Wagner-Weiner, L. ; Higgins, G. C. ; Brunner, H. I. ; Jung, L. K. ; Imundo, L. ; Soep, J. B. ; Reed, A. M. / Laboratory markers of cardiovascular risk in pediatri SLE : The APPLE baseline cohort. In: Lupus. 2010 ; Vol. 19, No. 11. pp. 1315-1325.
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T1 - Laboratory markers of cardiovascular risk in pediatri SLE

T2 - The APPLE baseline cohort

AU - Ardoin, S. P.

AU - Schanberg, L. E.

AU - Sandborg, C.

AU - Yow, E.

AU - Barnhart, H. X.

AU - Mieszkalski, K. L.

AU - Ilowite, N. T.

AU - Von Scheven, E.

AU - Eberhard, A.

AU - Levy, D. M.

AU - Kimura, Y.

AU - Silverman, E.

AU - Bowyer, S. L.

AU - Punaro, L.

AU - Singer, N. G.

AU - Sherry, D. D.

AU - McCurdy, D.

AU - Klein-Gitelman, M.

AU - Wallace, C.

AU - Silver, R.

AU - Wagner-Weiner, L.

AU - Higgins, G. C.

AU - Brunner, H. I.

AU - Jung, L. K.

AU - Imundo, L.

AU - Soep, J. B.

AU - Reed, A. M.

PY - 2010/10

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N2 - As part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) Trial, a prospective multicenter cohort of 221 children and adolescents with systemic lupus erythematosus (SLE) (mean age 15.7 years, 83% female) underwent baseline measurement of markers of cardiovascular risk, including fasting levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), lipoprotein A (Lpa), homocysteine and high-sensitivity C-reactive protein (hs-CRP). A cross-sectional analysis of the baseline laboratory values and clinical characteristics of this cohort was performed. Univariable relationships between the cardiovascular markers of interest and clinical variables were assessed, followed by multivariable linear regression modeling. Mean levels of LDL, HDL, Lpa, TG, hs-CRP and homocysteine were in the normal or borderline ranges. In multivariable analysis, increased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), prednisone dose, and hypertension (HTN) were independently associated with higher LDL levels. Higher hs-CRP and creatinine clearance were independently related to lower HDL levels. Higher body mass index (BMI), prednisone dose, and homocysteine levels were independently associated with higher TG levels. Only Hispanic or non-White status predicted higher Lpa levels. Proteinuria, higher TG and lower creatinine clearance were independently associated with higher homocysteine levels, while use of multivitamin with folate predicted lower homocysteine levels. Higher BMI, lower HDL, and longer SLE disease duration, but not SLEDAI, were independently associated with higher hs-CRP levels. The R2 for these models ranged from 7% to 23%. SLE disease activity as measured by the SLEDAI was associated only with higher LDL levels and not with hs-CRP. Markers of renal injury (HTN, proteinuria, and creatinine clearance) were independently associated with levels of LDL, HDL, and homocysteine, highlighting the importance of renal status in the cardiovascular health of children and adolescents with SLE. Future longitudinal analysis of the APPLE cohort is needed to further examine these relationships.

AB - As part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) Trial, a prospective multicenter cohort of 221 children and adolescents with systemic lupus erythematosus (SLE) (mean age 15.7 years, 83% female) underwent baseline measurement of markers of cardiovascular risk, including fasting levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), lipoprotein A (Lpa), homocysteine and high-sensitivity C-reactive protein (hs-CRP). A cross-sectional analysis of the baseline laboratory values and clinical characteristics of this cohort was performed. Univariable relationships between the cardiovascular markers of interest and clinical variables were assessed, followed by multivariable linear regression modeling. Mean levels of LDL, HDL, Lpa, TG, hs-CRP and homocysteine were in the normal or borderline ranges. In multivariable analysis, increased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), prednisone dose, and hypertension (HTN) were independently associated with higher LDL levels. Higher hs-CRP and creatinine clearance were independently related to lower HDL levels. Higher body mass index (BMI), prednisone dose, and homocysteine levels were independently associated with higher TG levels. Only Hispanic or non-White status predicted higher Lpa levels. Proteinuria, higher TG and lower creatinine clearance were independently associated with higher homocysteine levels, while use of multivitamin with folate predicted lower homocysteine levels. Higher BMI, lower HDL, and longer SLE disease duration, but not SLEDAI, were independently associated with higher hs-CRP levels. The R2 for these models ranged from 7% to 23%. SLE disease activity as measured by the SLEDAI was associated only with higher LDL levels and not with hs-CRP. Markers of renal injury (HTN, proteinuria, and creatinine clearance) were independently associated with levels of LDL, HDL, and homocysteine, highlighting the importance of renal status in the cardiovascular health of children and adolescents with SLE. Future longitudinal analysis of the APPLE cohort is needed to further examine these relationships.

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KW - cardiovascular

KW - lipid

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KW - systemic lupus erythematosus

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