Christine Chew1, John A Reynolds2,3, Apinya Lertratanakul4, Peggy Wu4, Murray Urowitz5, Dafna D Gladman5, Paul R Fortin6, Sang-Cheol Bae7, Caroline Gordon3, Ann E Clarke8, Sasha Bernatsky9, John G Hanly10, David Isenberg11, Anisur Rahman11, Jorge Sanchez-Guerrero5, Juanita Romero-Diaz12, Joan Merrill13, Daniel Wallace14, Ellen Ginzler15, Munther Khamashta16, Ola Nived17, Andreas Jönsen17, Kristjan Steinsson18, Susan Manzi19, Ken Kalunian20, Mary Anne Dooley21, Michelle Petri22, Cynthia Aranow23, Ronald van Vollenhoven24, Thomas Stoll25, Graciela S Alarcón26, S Sam Lim27, Guillermo Ruiz-Irastorza28, Christine A Peschken29, Anca D Askanase30, Diane L Kamen31, Murat İnanç32, Rosalind Ramsey-Goldman4, Ian N Bruce33,34. 1. Lydia Becker Institute of Immunology and Inflammation, Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester. 2. Department of Rheumatology, Sandwell and West Birmingham NHS Trust. 3. Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. 4. Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5. Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON. 6. Department of Rheumatology, Université Laval Faculté de médecine, Quebec, QC, Canada. 7. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea. 8. Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, University of Calgary Cumming School of Medicine, Calgary, AB. 9. Faculty of Medicine, Division of Rheumatology, McGill University, Montreal, QC. 10. Division of Rheumatology, Department of Medicine and Department of Pathology Halifax, Queen Elizabeth II Health Sciences Centre, NS, Canada. 11. Faculty of Medical Sciences, Division of Medicine, University College London, London, UK. 12. Immunology and Rheumatology Tlalpan, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, DF, Mexico. 13. Department of Clinical Pharmacology, Oklahoma Medical Research Foundation Arthritis and Clinical Immunology Research Program, Oklahoma City, OK. 14. Cedars-Sinai/David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, CA. 15. Department of Medicine, SUNY Downstate Medical Center College of Medicine, Brooklyn, NY, USA. 16. Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. 17. Faculty of Medicine, Department of Clinical Sciences Lund, Section of Rheumatology, Lunds University, Lund, Sweden. 18. Department of Rheumatology, National University Hospital of Iceland, Reykjavik, Iceland. 19. Allegheny Health Network, Lupus Center of Excellence, Pittsburgh, PA. 20. University of California San Diego School of Medicine, La Jolla, CA. 21. Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. 22. Department of Rheumatology, Johns Hopkins University School of Medicine Center for Musculoskeletal Research, Baltimore, MD. 23. Northwell Health Feinstein Institutes for Medical Research, Manhasset, NY, USA. 24. Amsterdam University Medical Centres, Duivendrecht, Noord-Holland, Netherlands. 25. Department of Rheumatology, Kantonsspital Schaffhausen, Schaffhausen, Schaffhausen, Switzerland. 26. Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL. 27. Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA. 28. Hospital Universitario Cruces, Autoimmune Diseases Units, Biocruces Bizkaia Health Research Institute, Barakaldo, País Vasco, Spain. 29. University of Manitoba, Winnipeg, MB, Canada. 30. Columbia University Irving Medical Center, New York, NY. 31. Medical University of South Carolina, Charleston, SC, USA. 32. Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul University Istanbul, Istanbul, Istanbul, Turkey. 33. Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, Greater Manchester. 34. Versus Arthritis Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Abstract
OBJECTIVES: Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance. METHODS: The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10-36 nmol/l), T2 (37-60 nmol/l) and T3 (61-174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels. RESULTS: Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance. CONCLUSIONS: MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.
OBJECTIVES: Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance. METHODS: The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10-36 nmol/l), T2 (37-60 nmol/l) and T3 (61-174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels. RESULTS: Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance. CONCLUSIONS: MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.
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