In a recent commentary titled “Dialogue: Vitamin D, statins and atherosclerotic progression in pediatric lupus” published in BMJ Lupus Science & Medicine, Gary Gilkeson from the Medical University of South Carolina and Sue Manzi from the Temple University School of Medicine discuss the major strengths and limitations in the recent studies published in the journal.
The studies consisted of two secondary analyses conducted by Dr. Robinson and colleagues as part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) study. The studies assessed the association of vitamin D levels at baseline with lipid status, inflammatory markers, season, ethnicity, and disease damage; and with progression of carotid intimal thickening in patients treated with atorvastatin.
APPLE examined the effect of statin therapy (atorvastatin) in the progression of atherosclerosis during 3-years in pediatric patients without hypercholesterolaemia. Results showed that there was no effect of statins on the progression of carotid intimal thickening. The Lupus Atherosclerosis Prevention Study retrieved similar results, as statin therapy had no effect on progression of atherosclerosis in adults suffering from lupus.
Evidence seems to be consistent in showing that Vitamin D has many biological effects including efficacy of statin therapy, atherosclerosis, bone health, autoimmune diseases and cancer. Patients with Lupus had been found to suffer from decreased levels of vitamin D, linked to increased experiences of lupus flares and damage in the end organ.
These observations provided the biological rationale for evaluating if vitamin D levels had an affect in the results of the APPLE trial. According to Gilkeson and Manzi, both studies provide important results concerning vitamin D, statins and atherosclerosis/CIMT.
However, the mechanisms of action for vitamin D amplification of statins’ effect still requires further testing. In the commentary, the authors note that study’s results reveal that patients with higher levels of vitamin D do not have lower levels of cholesterol, a decrease in disease activity or lower levels of high-sensitivity CRP (hsCRP).
As a concluding note, the authors state that screening for vitamin D deficiency along with the increasing use of vitamin D supplementation may raise problems in the evaluation of vitamin deficiency effects.