Background: Patients with pediatric Systemic Lupus Erythematosus (pSLE) are at increased risk of premature atherosclerosis irrespective of exposure to traditional cardiovascular risk factors. The goals of this study were to determine the progression of vascular markers of premature atherosclerosis in a prospectively followed pSLE cohort and the role of treatment and disease activity related factors.

Methods: At baseline and first follow-up drug therapy and disease activity were recorded, fasting lipid and glycemic profiles performed; and vascular markers including intima-media thickness (CIMT), flow-mediated dilatation (FMD), and pulse wave velocity (PWV) assessed. Differences between baseline and follow-up time points were tested as paired measures adjusted for time and compared in univariate analysis.

Results: Forty-three pSLE were assessed at baseline (age 14.0±2.8 years; disease duration 2.3±2.8 years, 81% female) and follow-up (1.6±0.5 years later). No overall difference was observed in CIMT (0.01±0.05 mm, p=0.15), FMD (0.19±5.0 %, p=0.81) and PWV (0.15±1.0 m/sec, p=0.39). When considering the time-dependent effects of treatment and disease activity on these vascular markers, corticosteroid use was found to be negatively associated with CIMT at follow-up (r=−0.44, p=0.004) and remained significant in a multiple variable model (R2=0.63, p<0.001).

Conclusion: In pSLE of relatively short duration, progression of vascular markers of premature atherosclerosis was not observed over short-term follow-up, but change in CIMT was found to be negatively associated with the amount of corticosteroid use. This suggests aggressive immunotherapy may reduce the atherogenic burden of chronic inflammation in pSLE and warrants further investigation.