Natural history of hypercholesterolemia in systemic lupus erythematosus

Objective. To determine the natural history of hypercholesterolemia in the first 3 years of disease in an inception cohort of patients with systemic l upus erythematosus (SLE) followed at a single center and to determine the i nfluence of hypercholesterolemia on the subsequent development of coronary artery dis ease (CAD) related events. Methods. We identified patients who were seen at the University of Toronto lupus clinic within 1 year of diagnosis from January 1, 1974, to December 3 1, 1987, and who were seen at least once a year in the first 3 years. Patie nts were divided into 3 groups: Normal cholesterol: serum total cholesterol (TC) < 5.2 mmol/l throughout the 3 year period of study. Sustained hyperch olesterolemia: at least one measurement of TC of > 5.2 mmol/l in each of th e first 3 years at the clinic. Variable hypercholesterolemia: TC > 5.2 mmol /l in no more than 2 of the first 3 years of followup. Patients were follow ed from inception until the present day. The primary outcome was the time o f the first CAD related event (myocardial infarction, angina, or sudden une xplained death). Results. One hundred thirty-four patients (118 women, 16 men) were studied, 33 (24.6%) had normal cholesterol, 54 (40.3%) had sustained hypercholester olemia. and 47 (35.1%) had variable hypercholesterolemia. Using multiple lo gistic regression the best predictors of sustained hypercholesterolemia wer e cumulative dose of steroids, no antimalarial therapy, and age of onset of SLE > 35 years old. CAD related events occurred in 1 (3%) of the normal TC group, 3 (6.4%) of the variable group, and in 15 (27.8%) of the sustained group (p = 0.003), 79% of all CAD events occurred in the sustained group. T he best predictors of CAD were sustained hypercholesterolemia. lung involve ment, and age at onset of SLE > 35 years. Conclusion. Within 3 years of diagnosis, 75.4% of patients with SLE had ele vated TC, which was sustained in 40.3% of all patients. Older age at onset as well as increased cumulative dose of steroids and no antimalarial therap y are significant predictors of this group. It is this group that experienc es the majority of CAD related events. Aggressive lipid lowering therapy sh ould be targeted at such patients.