Studies of Metabolic Syndrome in the SLICC Inception Cohort

Lead Investigators: IN Bruce, MB Urowitz, DD Gladman

New Investigator: Dr Ben Parker (Arthritis Research UK Clinical PhD Fellow): University of Manchester Funding Source: Canadian Institute for Health Research, Arthritis Research UK and National Institute for Health Research (UK)

The metabolic syndrome (MetS) may contribute to increased cardiovascular risk (CVD) in SLE. In these studies we aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS both at baseline and then over time with a particular focus on disease activity, disease phenotype and corticosteroid exposure over time. For these studies MetS was defined according to the 2009 Consensus Statement from the International Diabetes Federation.

At the time of study we had 1686 patients in the cohort of whom 1150 (68.2%) had sufficient data to determine their MetS status. MetS was present in 38.2% at enrollment, 34.8% at year 1 and 35.4% at year 2. At the baseline visit, higher peak oral prednisolone dose (mg) (OR [95% CI] 1.02 [1.01, 1.03]), cumulative corticosteroid dose (g) (1.07 [1.01, 1.12]), older age (years) (1.05 [1.04, 1.07]), Korean (2.07 [1.31, 3.25]), Hispanic (1.79 [1.13, 2.87]) and African Ancestry (2.73 [1.46, 5.12]) race/ethnicity, and current renal disease (2.70 [1.83, 3.99]) were associated with MetS. Antimalarial use was associated with a reduced risk of MetS (0.53 [0.37, 0.75]).

In a longitudinal analysis over the first 2 years of follow-up prior MetS status, baseline renal disease, SLICC Damage Index >1, higher disease activity, increasing age, Hispanic race/ethnicity or African ancestry were independently associated with MetS over time.

MetS is a persistent phenotype in a significant proportion of SLE patients. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development whilst antimalarials appear to be protective from early in the disease course. We also note that several race/ethnicity subsets are more prone to developing MetS. As MetS is a recognised risk factor for future CVD it serves to help us better understand the mechanisms of CVD risk in SLE. We also conclude that balancing disease control and minimizing corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.


References:

  • 1.Parker B, Urowitz MB, Gladman DD, Lunt M, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Gordon C, Wallace DJ, Clarke AE, Bernatsky S, Ginzler EM, Isenberg DA, Rahman A, Merrill JT, Alarcón GS, Fessler BJ, Fortin PR, Hanly JG, Petri M, Steinsson K, Dooley MA, Manzi S, Khamashta MA, Ramsey-Goldman R, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven RF, Kalunian KC, Ruiz-Irastorza G, Lim S, Kamen DL, Peschken CA, Inanc M, Bruce IN. Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis. 2013; 72:1308-14.
  • 2.Parker B, Bruce I. SLE and metabolic syndrome. Lupus. 2013; 22:1259-66.
  • 3.Parker B, Urowitz MB, Gladman DD, Lunt M, Donn R, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Gordon C, Wallace DJ, Clarke AE, Bernatsky S, Ginzler EM, Isenberg DA, Rahman A, Merrill JT, Alarcón GS, Fessler BJ, Fortin PR, Hanly JG, Petri M, Steinsson K, Dooley MA, Manzi S, Khamashta MA, Ramsey-Goldman R, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven RF, Kalunian KC, Ruiz-Irastorza G, Lim SS, Kamen DL, Peschken CA, Inanc M, Bruce IN. Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis. 2015; 74: 1530-6.

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