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Longitudinal examination of lipid profiles in pediatric systemic lupus erythematosus
Talin Sarkissian1, Joseph Beyene, Brian Feldman
1The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Pediatric systemic lupus erythematosus (SLE) patients show abnormal lipid profiles due to active disease and prednisone. Lipid levels are influenced by disease activity, proteinuria, and steroid dosage.
Area of Science:
- Pediatric Rheumatology
- Cardiovascular Risk in Autoimmune Diseases
- Clinical Lipidology
Background:
- Lipid abnormalities are frequent in systemic lupus erythematosus (SLE), contributing to premature atherosclerosis.
- Understanding these changes in pediatric SLE is crucial for managing long-term cardiovascular health.
Purpose of the Study:
- To serially examine lipid profiles in pediatric SLE patients.
- To determine the influence of disease activity and prednisone therapy on lipid levels.
Main Methods:
- Serial lipid measurements (cholesterol, triglycerides, LDL, HDL) in 139 pediatric SLE patients.
- Correlation of lipid levels with disease activity and prednisone dosage.
- Analysis of lipid changes in relation to proteinuria and nephritis.
Main Results:
- Abnormal lipid levels were common at SLE diagnosis.
- Prednisone dose reduction correlated with decreased cholesterol and triglycerides.
- Proteinuria was linked to altered cholesterol, triglycerides, and LDL; active nephritis to HDL changes.
- Increased prednisone dose was associated with higher lipid levels, including HDL, in the absence of nephrotic-range proteinuria.
Conclusions:
- Active SLE contributes to a proatherogenic lipid profile.
- Cholesterol and LDL levels are primarily linked to prednisone dose and high disease activity.
- Triglyceride levels correlate with proteinuria, and HDL changes with active SLE and high-dose prednisone.
- Pediatric SLE lipid profiles result from a complex interplay of disease activity and corticosteroid treatment.
Objective:
Lipid abnormalities in patients with systemic lupus erythematosus (SLE) are common and are likely to be one of the causes of premature atherosclerosis in these patients. This study was undertaken to serially examine the lipid profile in pediatric patients with SLE to determine the roles of active disease and therapy in altering lipid levels.
Methods:
Serial lipid measurements were obtained in an inception cohort of 139 pediatric patients with SLE at the time of treatment with either a constant dose or differing doses of prednisone, and annually. The levels of cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were correlated with measures of disease activity and prednisone dose.
Results:
At the time of SLE diagnosis in this pediatric cohort, the mean values for all lipids were abnormal. With each reduction in prednisone dose, there was a statistically significant decrease in cholesterol and triglyceride levels (P < 0.001) but not HDL or LDL levels. Nephrotic-range proteinuria was associated with altered cholesterol, triglyceride, and LDL levels, whereas changes in HDL were more commonly associated with active nephritis. In the absence of nephrotic-range proteinuria, increases in prednisone dose were associated with increased levels of all lipids, including HDL.
Conclusion:
Active SLE leads to a proatherogenic lipid profile. Levels of cholesterol and LDL were mainly associated with the dose of prednisone, and were abnormal only during very high disease activity. Triglyceride levels were mainly associated with proteinuria, while changes in HDL were associated with active SLE and a high dose of prednisone. Our results suggest that the lipid profile in pediatric SLE is the result of a complex interaction of disease manifestations and the effects of prednisone therapy.
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