Cardiovascular disease, specifically from atherosclerosis, is the major cause of mortality
in systemic lupus erythematosus (SLE) in developed countries. Coronary artery disease and
stroke contribute to long-term morbidity in surviving patients. Atherosclerosis in SLE is
multifactorial, with immune/inflammatory endothelial damage, traditional cardiovascular risk
factors, and prothrombotic factors all playing important roles. Multiple groups have shown
that hyperlipidemia is predictive of later atherosclerosis in SLE. In the general
population, statins have become the drug of choice in preventing atherosclerotic events,
through two mechanisms: lipid lowering that helps to prevent progression, and stabilization
of plaques to prevent rupture. In the Lupus Atherosclerosis Prevention Trial we will
determine if atorvastatin reduces the progression of atherosclerosis on helical computed
tomography (CT) and carotid duplex. Recent work has confirmed that statins have an
immunomodulatory role. This study will also determine whether statins improve clinical lupus
activity or lupus serologies (anti-dsDNA and complement).
- Patients with a clinical diagnosis of SLE, confirmed by a faculty rheumatologist
at Johns Hopkins.
- Patients must be 18 years of age or older
- Give informed consent.
- SLE patients with a known atherosclerotic event, such as angina, myocardial
infarction, or stroke, with an abnormal lipid profile for which a statin would be
standard of care, are excluded.
- Pregnant patients (or patients planning to become pregnant in the next two years) are
- Patients who have known chronic liver disease, have unexplained elevation of their
liver enzymes greater than 2 times the upper limit of normal , or an elevated CPK
greater than 1.5 times the upper limit of the normal value for the patient’s racial
group, are excluded.
- Patients with triglycerides greater than 500 mg/dl or LDL greater than 190 in the
absence of 2 risk factors (and who are unwilling to participate in a formal
nutritional/lifestyle modification program that we recommend for them) are excluded.