Joyce C. Chang, MD MSCE
2018 Career Development Awardee
Children’s Hospital of Philadelphia
Study: Attenuated Nocturnal Blood Pressure Dipping and Subclinical Atherosclerosis in Child-Onset Lupus
Mentors: Andrea M. Knight, Pamela F. Weiss
About the Researcher
Dr. Chang is an attending physician in the Division of Rheumatology at the Children’s Hospital of Philadelphia (CHOP), Assistant Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and a core faculty member of the Center for Pediatric Clinical Effectiveness (CPCE) at CHOP. She completed fellowship in Pediatric Rheumatology at CHOP in 2018 and received a Master of Science in Clinical Epidemiology from the Perelman School of Medicine at the University of Pennsylvania. From a clinical perspective, she cares for children and adolescents in the Lupus Integrated Nephritis Clinic and is involved in improving the quality of pediatric lupus care and transition to adult care. Her research focuses on the epidemiology and outcomes of childhood-onset lupus, including cardiovascular outcomes and health services use. She has also collaborated with pediatric cardiologists and nephrologists to study the interpretation of non-invasive measures of cardiovascular health in children with lupus. Her goals are to develop modifiable measures of cardiovascular risk that can be used to improve long-term health outcomes of children with lupus.
Childhood-onset systemic lupus erythematosus (SLE) carries a high risk of cardiovascular disease due to premature atherosclerosis, but effective monitoring and prevention strategies are currently lacking. The presence of nocturnal hypertension and attenuated nocturnal blood pressure dipping on ambulatory blood pressure monitoring (ABPM) have emerged as important predictors of cardiovascular events in adults, and could potentially serve as easily measured, modifiable risk factors in childhood-onset SLE. However, there is a gap in knowledge regarding nocturnal blood pressure abnormalities in childhood-onset SLE and their relationship to subclinical atherosclerosis, especially markers of endothelial function, arterial stiffness, and carotid intima-media thickness. Understanding the relationship between nocturnal blood pressure and functional or structural vascular changes could inform treatment targets in childhood-onset SLE. This will be a cross-sectional study of children with SLE recruited to undergo ABPM and comprehensive vascular profiling (EndoPAT, pulse wave velocity, carotid ultrasound, echocardiography and serum lipids). The aims of this proposal are to: 1) estimate the prevalence of and factors associated with nocturnal hypertension and attenuated nocturnal blood pressure dipping in childhood-onset SLE, and 2) determine the association between attenuated nocturnal dipping with non-invasive vascular measures of subclinical atherosclerosis. This project will provide preliminary data for larger, longitudinal studies examining treatment-related factors and serum biomarkers associated with accelerated atherosclerosis in childhood-onset SLE.
For an update on Dr. Chang's research, click here.
What was the result/impact of your award?
The LFA grant gave me the necessary support to obtain additional research training and complete a project that I was really passionate about. I was able to use the results of this project as the basis for a National Institutes of Health (NIH) grant application. In addition, the award gave me access to crucial institutional resources as a career development awardee, which allowed me to do innovative work that I would not otherwise have had the resources to do this early in my career. Most importantly, the guidance from my superb mentoring team for this award has allowed me to grow as an investigator and develop collaborative multidisciplinary relationships that will facilitate future work.
For more information on Lupus Foundation on America’s granted research, please contact Ashley Marion at [email protected]