Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort

• Published in: Rheumatology (Oxford, England) Vol. 60; no. 10; pp. 4737 - 4747
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.10.2021
• Subjects: Adult; Cardiovascular disease; Clinical Medicine; Clinical Science; Cohort Studies; Cross-Sectional Studies; Endocrinology and Diabetes; Endokrinologi och diabetes; Epidemiology; Female; Global Health - statistics & numerical data; Humans; Insulin Resistance; Klinisk medicin; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - complications; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Metabolic Syndrome - epidemiology; Metabolic Syndrome - etiology; Systemic lupus erythematosus; Vitamin D; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - epidemiology; Young Adult; cardiovascular disease; epidemiology; systemic lupus erythematosus; vitamin D
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/keab090

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.