Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort.
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Chew Christine, Reynolds John A, Lertratanakul Apinya, Wu Peggy, Urowitz Murray, Gladman Dafna D, Fortin Paul R, Bae Sang-Cheol, Gordon Caroline, Clarke Ann E, Bernatsky Sasha, Hanly John G, Isenberg David, Rahman Anisur, Sanchez-Guerrero Jorge, Romero-Diaz Juanita, Merrill Joan, Wallace Daniel, Ginzler Ellen, Khamashta Munther, Nived Ola, Jönsen Andreas, Steinsson Kristjan, Manzi Susan, Kalunian Ken, Dooley Mary Anne, Petri Michelle, Aranow Cynthia, van Vollenhoven Ronald, Stoll Thomas, Alarcón Graciela S, Lim S Sam, Ruiz-Irastorza Guillermo, Peschken Christine A, Askanase Anca D, Kamen Diane L, İnanç Murat, Ramsey-Goldman Rosalind, Bruce Ian N
Аннотация
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.