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Dialogue: Vitamin D, statins and atherosclerotic progression in paediatric lupus
  1. Gary Gilkeson1 and
  2. Sue Manzi2
  1. 1Department of Medicine, Medical University of South Carolina and the Medical Research Service, Ralph H. Johnson, VAMC, Charleston, South Carolina, USA
  2. 2Department of Medicine, Allegheny Health Network, and Professor Medicine Temple University School of Medicine, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Gary S Gilkeson; gilkeson{at}

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In the last six months, Lupus Science and Medicine has published two papers by Robinson et al1 ,2 that were secondary analyses and substudies of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) study. The major emphasis of the two papers was (1) the association of vitamin D levels at baseline with inflammatory markers, ethnicity, season, lipid status and disease damage in the first paper,  (2) and with progression of carotid intimal thickening in patients treated with atorvastatin in the second paper. The original APPLE study was designed to evaluate whether statin therapy (atorvastatin) could affect atherosclerosis progression over a 3-year period in paediatric patients without hypercholesterolaemia.3 The significance of this study is obvious, given the accelerated atherosclerosis reported in patients with lupus. There was no statistically significant effect of atorvastatin on carotid intimal thickening progression. Studying underlying mechanisms of this proatherosclerotic effect of lupus in paediatric patients devoid of many of the confounding risk factors present in adults with lupus provides an opportunity to assign causation and response to treatment. The Lupus Atherosclerosis Prevention Study4 assessed the effect of statins on atherosclerotic disease progression in 200 adults with no clinical evidence of vascular disease and without elevated cholesterol levels. Like the APPLE study, statin therapy had no significant impact on atherosclerotic progression in adults with lupus. The studies published in Lupus Science and Medicine addressed whether vitamin D status at baseline affected progression of carotid atherosclerosis.

Vitamin D is reported to …

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