Background/Purpose: The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) has provided education and guidance for decades on the management of hypercholesterolemia. Systemic lupus erythematosus (SLE) patients are in an intermediate risk category for cardiovascular disease. We examined a SLE cohort to examine whether patients were being treated according to ATP III guidelines.

Methods: Data from 133 patients with SLE was examined to see whether ATP III guidelines were being adhered to. All patients were free of any known clinical heart disease. Available information that was used included traditional CVD risk factors (a history (or present use) of cigarettes, hypertension (HTN) (BP ≥ 140/90 mmHg or on an antihypertensive agent for the purpose of lowering blood pressure), HDL cholesterol < 40 mg/dL, family history of premature CVD, diabetes (self reported history or a fasting blood glucose of >126 mg/dL), fasting cholesterol profiles, and age (men ≥ 45 years; women ≥ 55 years). We then compared the proportion of SLE patients who met ATP III criteria for initiation of lipid therapy and who reported ever having been/ or were presently on therapy to those who had never been on a lipid lowering medication. We evaluated group differences between those patients who have been treated versus those who have not using t-tests and chi-square analyses.

Results: The mean age of the cohort was 50.7 ± 8.8 years, 96% were female, and 78% were Caucasian. Thirty-four of the 133 (26%) participants met ATP III criteria for the initiation of lipid lowering therapy. Only 9 (26%) in this group had ever been on any lipid lowering medication and only 4 (12%) were currently being treated. Significant variables associated with lipid lowering therapy versus no therapy included, the mean number of ATP III risk factors (4.8 versus 4.0; p=0.03), body mass index (35.4 versus 27.8; p=0.001), age (50.2 vs. 57.3 years; p=0.02), cholesterol level (249 versus 187 mg/dL; p<0.0001), LDL (163 vs. 109 mg/dL; p<0.0001), and HTN (78% vs. 40%; p=0.03). Race, SLICC scores, diabetes, HDL, family history, and smoking were not significant variables as to whether a patient was treated.

Conclusion: ATP III guidelines are standard guidelines for assessing whether patients should have interventions, including drug therapy, to treat hyperlipidemia and decrease CVD risk. More than a quarter of our SLE participants met ATP III guidelines for lipid lowering therapy and only 12% of those who fulfilled ATP III criteria were being treated. Younger patients who met criteria were not treated, while older, obese, and those with a higher number of ATP III risk factors were treated. Given that SLE patients are already at an intermediate CVD risk, similar to diabetes, more awareness is needed in addressing the needs of this at-risk population. This is an excellent area for quality improvement for rheumatologists and highlights the need for communication between rheumatologists and primary physicians regarding treatment and/or referral to cardiology for primary preventative care. Future studies addressing obstacles in initiation and maintenance of therapy are needed in SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-adult-treatment-panel-iii-guidelines-for-systemic-lupus-patients/