Background The Metabolic Syndrome (MetS) is a clustering of metabolic abnormalities associated with an increased risk of developing diabetes and atherosclerosis, and may add to the increased cardiovascular risk seen in SLE. Inflammatory disease activity and therapeutic exposures, particularly to corticosteroids, may contribute to the development of MetS in SLE.
Objectives We examined the impact of inflammation and corticosteroid exposure on the prevalence of MetS in a multicentre international inception cohort of patients with SLE.
Methods The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis (SLICC-RAS) inception cohort enrolled recently diagnosed (<15 months) SLE patients from 30 centres across 11 countries since 2000. Baseline and annual assessments record clinical, laboratory and therapeutic data according to a standardized protocol. MetS was defined according to the 2009 Consensus Statement from the International Diabetes Federation. Multivariate logistic regression was used to examine the association between MetS and markers of inflammation, disease phenotype and corticosteroid exposure at the baseline enrolment visit into SLICC-RAS.
Results Of the 1686 available patients at enrolment, 1494 (86.6%) had sufficient data to determine their MetS status. Mean (SD) age at enrolment was 35.2 (13.4) years, mean (SD) disease duration was 24.1 (18.0) weeks and 89.2% were female. The overall prevalence of MetS in this cohort was 16%. The prevalence was higher with increasing age, in those of Hispanic and Korean ethnicities compared to Caucasians (31.3% vs. 30.1% vs. 12.1%; p≤0.001), and in males compared to females (22.2% vs. 15.3%; p=0.03). Significant factors on univariate analysis, adjusted for age, race and sex, included: current corticosteroid use (OR 1.54 (1.04, 2.25)); current average prednisolone dose (mg) (OR 1.02 (1.01, 1.04)); cumulative prednisolone dose (g) (OR 1.05 (1.00, 1.09)); previous IV corticosteroid use (OR 3.22 (1.35, 7.68)); current anti-malarial use (OR 0.51 (0.38, 0.68)); current immunosuppressant use (or 2.21 (1.63, 3.00)); SLEDAI 2K (OR 1.05 (1.02, 1.07)); active renal disease (OR 2.87 (2.05, 4.02));and thrombocytopenia (OR 2.08 (1.02, 4.24)). The final model using multivariate analysis included age, Hispanic or Korean ethnicity, average steroid dose, active renal disease and immunosuppressive use (Table 1).
Conclusions In this large multinational study of young, recently diagnosed SLE patients, MetS is associated with both severe inflammatory disease and exposure to higher doses of corticosteroids. The strong association of MetS with Korean and Hispanic ethnicities suggests that susceptibility to the adverse metabolic effects of both inflammation and corticosteroid exposure is also at least in part genetically determined.
Disclosure of Interest None Declared
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