Objective: To evaluate dietary therapy in the treatment of hyperlipidemia in patients with systemic lupus erythematosus (SLE).
Methods: Using the National Cholesterol Education Program (NCEP) guidelines, we screened 89 patients with SLE for hyperlipidemia. Step 1 dietary therapy was instituted in 28 patients as recommended by the NCEP. Twenty-six patients failed Step 1 intervention and received Step 2 dietary therapy for an additional 3 months. Twenty-nine control patients with SLE were tested for hyperlipidemia.
Results: The 89 patients with SLE (94% women, 77% black) had a mean age of 37.2 years. Fasting values were total cholesterol (TC) 6.22 +/- 0.16 mmol/l (240.9 +/- 6.0 mg/dl), low density lipoprotein cholesterol (LDL-C) 4.08 +/- 0.14 mmol/l, (157.6 +/- 5.3 mg/dl), high density lipoprotein (HDL-C) 1.37 +/- 0.08 mmol/l (53.0 +/- 3.1 mg/dl), and triglyceride (TG) 1.71 +/- 0.12 mmol/l, (151.9 +/- 10.6 mg/dl). The mean dose of prednisone was 14.2 +/- 1.6 mg/day. Prednisone dose correlated with levels of TC (p < 0.01) by linear regression. The 28 patients receiving Step 1 dietary intervention had TC 6.11 +/- 0.19 mmol/l (236.4 +/- 7.3 mg/dl), LDL-C 4.05 +/- 0.19 mmol/l (156.6 +/- 7.5 mg/dl), HDL-C 1.31 +/- 0.08 mmol/l (50.7 +/- 3.0 mg/dl), and TG 1.64 +/- 0.12 mmol/l (145.4 +/- 10.3 mg/dl). The 26 patients receiving Step 2 dietary intervention had TC 5.84 +/- 0.17 mmol/l (226.0 +/- 6.6 mg/dl), LDL-C 3.83 +/- 0.19 mmol/l (148.0 +/- 7.2 mg/dl), HDL-C 1.25 +/- 0.08 mmol/l (48.5 +/- 3.2 mg/dl), and TG 1.66 +/- 0.15 mmol/l (147.1 +/- 13.4 mg/dl). The mean prednisone dose was 14.8 +/- 3.0 mg/day for both study groups. There was no significance between prednisone doses in all groups studied (p = 0.08). After 6 months of dietary therapy, there was a significant decrease in only the TC (p = 0.158).
Conclusion: TC correlated directly with the prednisone dose. Six months of dietary intervention was required to significantly decrease the TC. Further management of hyperlipidemia will probably require drug intervention.