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

• Published in: Annals of the rheumatic diseases Vol. 72; no. 8; pp. 1308 - 1314
• Main Authors: Parker, Ben, Urowitz, Murray B, Gladman, Dafna D, Lunt, Mark, Bae, Sang-Cheol, Sanchez-Guerrero, Jorge, Romero-Diaz, Juanita, Gordon, Caroline, Wallace, Daniel J, Clarke, Ann E, Bernatsky, Sasha, Ginzler, Ellen M, Isenberg, David A, Rahman, Anisur, Merrill, Joan T, Alarcón, Graciela S, Fessler, Barri J, Fortin, Paul R, Hanly, John G, Petri, Michelle, Steinsson, Kristjan, Dooley, Mary-Anne, Manzi, Susan, Khamashta, Munther A, Ramsey-Goldman, Rosalind, Zoma, Asad A, Sturfelt, Gunnar K, Nived, Ola, Aranow, Cynthia, Mackay, Meggan, Ramos-Casals, Manuel, van Vollenhoven, Raymond F, Kalunian, Kenneth C, Ruiz-Irastorza, Guillermo, Lim, Sam, Kamen, Diane L, Peschken, Christine A, Inanc, Murat, Bruce, Ian N
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and European League Against Rheumatism 01.08.2013; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Extended report
• Subjects: Adult; Asia - epidemiology; Cardiovascular Disease; Clinical and Epidemiological Research; Clinical Medicine; Cohort Studies; Comorbidity; Endokrinologi och diabetes; Epidemiology; Europe - epidemiology; Female; Health risk assessment; Humans; Inflammation; International Cooperation; Klinisk medicin; Lupus; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - epidemiology; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Metabolic syndrome; Metabolic Syndrome - diagnosis; Metabolic Syndrome - epidemiology; North America - epidemiology; Prevalence; Registries; Reumatologi; Reumatologi och inflammation; Rheumatology and Autoimmunity; Studies; Systemic Lupus Erythematosus; Cardiovascular Disease; Systemic Lupus Erythematosus; Inflammation; Epidemiology
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/annrheumdis-2012-202106

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.