EFFECT OF PREDNISONE AND HYDROXYCHLOROQUINE ON CORONARY-ARTERY DISEASE RISK-FACTORS IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A LONGITUDINAL DATA-ANALYSIS

PURPOSE: To determine the effect of prednisone dose and hydroxychloroq uine dose on the coronary artery disease risk factors serum cholestero l level, mean arterial blood pressure, and weight in patients with sys temic lupus erythematosus. PATIENTS AND METHODS: A longitudinal cohort study of 264 patients with systemic lupus erythematosus was conducted . For all patients in the cohort, serum cholesterol, mean arterial pre ssure, weight, prednisone dose, hydroxychloroquine dose, and other pot ential confounding variables were recorded at each visit. Regression a nalysis appropriate for longitudinal data was used to assess the effec t of prednisone on serum cholesterol and mean arterial pressure. To as sess the effect of prednisone on weight, patients' weights were compar ed 90 days before and after a 10-mg or 20-mg increase in prednisone. R ESULTS: A total of 3,027 patient visits were analyzed. In the regressi on model for serum cholesterol, a change in prednisone dose of 10 mg w as associated with a change in cholesterol of 7.5 +/- 1.46 (SE) mg% af ter adjustment for the other significant variables in the model, inclu ding sex, race, hydroxychloroquine dose, and proteinuria. In the regre ssion model for hydroxychloroquine, the 200-mg and the 400-mg dose wer e both associated with lower serum cholesterol (8.9 +/- 3.44 SE mg%). In the regression model for mean arterial blood pressure, a 10-mg chan ge in prednisone dose led to a change in mean arterial blood pressure of 1.1 mm Hg after adjustment for age, weight, and antihypertensive dr ug use. A 10-mg increase in prednisone dose was associated with a mean weight change of 5.50 +/- 1.23 (SE) lb. CONCLUSIONS: Changes in predn isone dose led to definable changes in risk factors for coronary arter y disease, even after adjustment for other variables known to affect t hese risk factors. According to longitudinal regression analysis, hydr oxychloroquine therapy was associated with lower serum cholesterol.