Background Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease characterized by varied clinical manifestations. It mainly affects women of childbearing age and varies in intensity from a mild disease with skin lesions and arthritis to a devastating disease with renal, cardiac and profound disturbances of the central nervous system. In recent decades, due to the increased survival of patients with SLE, new complicationsand comorbidities have been recognized. Among these is cardiovascular disease atherosclerosis (CAD). Metabolic syndrome (MetS) is defined by the World Health Organization (WHO) as a set of metabolic alterations that commonly manifest together and are risk factors for coronary artery disease (CAD). Each component by it self, increases the risk of CAD, however, when combined, become more intense. These factors include hypertension, disturbed glucose metabolism, central obesity, and dyslipidemia. SM contributes to an 1.5-2.5 fold increase in mortality in CAD.
Objectives To analyze the prevalence of MetS in SLE according to the consensus applicable to different populations. To correlate the clinical, laboratory and treatment features with the occurrence of MetS. Tif TNF-α levels are independently associated with presence of MetS in SLE.
Methods We screened consecutive SLE patients followed in a longitudinal cohort at the rheumatology unit at the State University of Campinas. Controls were matched for age, sex and demographic background. SLE patients were assessed for disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] both at study entry and over time. Total dose of prednisone was calculated in prednisone equivalent during the entire follow-up period. MetS was assessed using the definitions recommended by the Brazilian Society of Cardiology. We determined height, weight, waist circumference (WC) and hip circumference (HC), measurements and fractions of cholesterol and fasting glucose levels for each individual. The reference values were adjusted according to age, as recommended by The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEPIII) definition.TNF-α levels were measured by ELISA.
Results We included 120 (95% female) patients with a mean age of 41.20±11.87 years and 106 controls with mean age of 36.32±14.26 years (p=0.006). We identified 45 (37.5%) SLE patients and 11 (10.38%) controls with MetS (p<0.001). We found no association between the presence of MetS variables and TNF-α (p=0.902), SDI (p=0.187) and SLEDAI (p=0.562).
Conclusions SLE patients have a higher prevalence of MetS than the general population. The higher risk of coronary disease and atherosclerosis makes the evaluation of MetS imperative in SLE patients. TNF-α was not associated with MetS in this cohort.
Disclosure of Interest F. Peres Grant/Research support from: FAPESP: 2010/10523-2, N. Sinicato Grant/Research support from: 2010/13637-9, M. Postal Grant/Research support from: 2009/11076-2, K. Peliçari Grant/Research support from: 2010/13636-2, A. Ferrari: None Declared, L. Costallat: None Declared, S. Appenzeller Grant/Research support from: 2008/02917-0