Nephrotic-range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus

Objective. To determine the presence of early carotid atherosclerosis and a ssociated risk factors in patients with juvenile-onset systemic lupus eryth ematosus (SLE). Methods. The carotid intima-media wall thickness (IMT) was measured by B-mo de ultrasound in patients with SLE onset before the age of 16 years and in sex- and age-matched healthy control subjects. Risk factors for atheroscler osis were determined at the time of the ultrasound scan and included tradit ional cardiovascular and SLE-related risk factors. Results. Twenty-six patients with juvenile-onset SLE and 26 healthy control s were studied, The mean (+/-SD) IMT of the SLE patients was significantly higher than that of the control group (0.57 +/- 0.05 mm and 0.54 +/- 0.03 m m, respectively; P = 0.006). The results of IMT measurement were not correl ated with the patients' age, disease duration, SLE Disease Activity Index ( SLEDAI) score, Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (DI) score, laboratory ind icators of lupus activity, or cumulative prednisone dose, Patients with nep hrotic-range (NR) proteinuria (greater than or equal to 3.5 gm/24 hours; n = 6) had a significantly higher IMT than did those without (n = 20) (P = 0. 02). Patients with NR proteinuria also had significantly higher SLEDAI scor es, SLICC/ACR DI scores, and systolic and diastolic blood pressures, and si gnificantly higher levels of total cholesterol, low-density lipoprotein cho lesterol, apolipoprotein B, and fibrinogen, No difference in any of the abo ve variables, including the IMT, was observed when SLE patients without NR proteinuria were compared with healthy controls. Conclusion. These patients with juvenile-onset SLE had ultrasonographic evi dence of premature atherosclerosis. The risk of early atherosclerosis may b e higher in patients with NR proteinuria.