Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

• Type of Material: Article
• Authors: Ben Parker, The University of Manchester; Murray B. Urowitz, University of Toronto; Dafna D. Gladman, University of Toronto; Mark Lunt, The University of Manchester; Sang-Cheol Bae, Hanyang University; Jorge Sanchez-Guerrero, Instituto Nacional de Ciencias Medicas y Nutrición; Juanita Romero-Diaz, Instituto Nacional de Ciencias Medicas y Nutrición; Caroline Gordon, University of Birmingham; Daniel J. Wallace, University of California Los Angeles; Ann E. Clarke, McGill University; Sasha Bernatsky, McGill University Health Centre, Montreal; Ellen M. Ginzler, SUNY Downstate Medical Center; David A. Isenberg, University College London; Anisur Rahman, University College London; Joan T. Merrill, Oklahoma Medical Research Foundation; Graciela S. Alarcon, University of Alabama at Birmingham; Barri J. Fessler, University of Alabama at Birmingham; Paul R. Fortin, Centre Hospitalier Universitaire de Québec et Université Laval; John G. Hanly, Queen Elizabeth II Health Sciences Centre and Dalhousie University; Michelle Petri, Johns Hopkins University; Kristjan Steinsson, Landspitali University Hospital; Mary-Anne Dooley, University of North Carolina, Chapel Hill; Susan Manzi, West Penn Allegheny; Munther A. Khamashta, King's College London School of Medicine; Rosalind Ramsey-Goldman, Northwestern University and Feinberg School of Medicine; Asad A. Zoma, Hairmyres Hospital; Gunnar K. Sturfelt, University Hospital Lund; Ola Nived, University Hospital Lund; Cynthia Aranow, Feinstein Institute for Medical Research; Meggan Mackay, Feinstein Institute for Medical Research; Manuel Ramos-Casals, Hospital Clínic, Barcelona; Raymond F. van Vollenhoven, Karolinska Institute; Kenneth C. Kalunian, UCSD School of Medicine; Guillermo Ruiz-Irastorza, University of the Basque Country; S Sam Lim, Emory University; Diane L. Kamen, Medical University of South Carolina, Charleston; Christine A. Peschken, University of Manitoba; Murat Inanc, Istanbul University; Ian N. Bruce, The University of Manchester
• Language: English
• Date: 2013-08
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1136/annrheumdis-2012-202106
• Title of Journal or Parent Work: Annals of the Rheumatic Diseases
• ISSN: 0003-4967
• Volume: 72
• Issue: 8
• Start Page: 1308
• End Page: 1314
• Grant/Funding Information: Additional author support: BP (Arthritis Research clinical research fellowship); RR-G (NIH grants UL1 RR025741, P60AR 30692, K24 AR 002138); MP (Hopkins Lupus Cohort NIH grant RD-1 43727); GR-I (Department of Education, Universities and Research, Basque Government); SB (Singer Family Fund for Lupus Research).; This study was funded by the Canadian Institutes of Health Research (grant number 93695), Arthritis Research UK (Arthritis Research UK Epidemiology Unit core support programme grant) and independent research supported by the National Institute for Health Research Biomedical Research Unit funding scheme and the NIHR Manchester Biomedical Research Centre (BP, ML, INB).
• Keywords: CORONARY-HEART-DISEASE; Science & Technology; Epidemiology; DIABETES-FEDERATION; Rheumatology; CHOLESTEROL; Systemic Lupus Erythematosus; Inflammation; ACCELERATED ATHEROSCLEROSIS; INSULIN LEVELS; LOW-DENSITY-LIPOPROTEIN; TREATMENT PANEL-III; WOMEN; RHEUMATOLOGY; RISK-FACTORS; Life Sciences & Biomedicine; PREVALENCE; Cardiovascular Disease
• Research Categories: Health Sciences, Immunology; Health Sciences, Epidemiology; Health Sciences, Pharmacology

Abstract

Background The metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS. Methods The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed ( < 15 months) SLE patients from 30 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected according to a standardised protocol. MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Univariate and backward stepwise multivariate logistic regression were used to assess the relationship of individual variables with MetS. Results We studied 1686 patients, of whom 1494 (86.6%) had sufficient data to determine their MetS status. The mean (SD) age at enrolment and disease duration was 35.2 years (13.4) and 24.1 weeks (18.0), respectively. MetS was present at the enrolment visit in 239 (16%). In backward stepwise multivariable regression analysis, higher daily average prednisolone dose (mg) (OR 1.02, 95% CI 1.00 to 1.03), older age (years) (OR 1.04, 95% CI 1.03 to 1.06), Korean (OR 6.33, 95% CI 3.68 to 10.86) and Hispanic (OR 6.2, 95% CI 3.78 to 10.12) ethnicity, current renal disease (OR 1.79, 95% CI 1.14 to 2.80) and immunosuppressant use (OR 1.81, 95% CI 1.18 to 2.78) were associated with MetS. Conclusions Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity are associated with MetS in SLE patients. Balancing disease control and minimising corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.