Objectives To study the association between the metabolic syndrome (MetS) and vascular events, end stage renal failure (ESRF) and mortality in patients with SLE
Methods Patients who fulfilled ≥4 1997 ACR criteria for SLE and were followed in the rheumatology clinics of Tuen Mun Hospital, Hong Kong were studied. Inclusion criteria were those who had clinical and laboratory assessment for the presence of the MetS within 5 years of the latest date of follow-up or death. The MetS was defined by the updated joint consensus criteria, using the Asian criteria for central obesity, when ≥3 of the following components were present: (1) Increased waist circumference to ≥90cm in men or ≥80cm in women; (2) Elevated blood pressure to ≥130/85mmHg or requiring drug therapy; (3) Elevated serum triglyceride level to ≥1.7mmol/L; (4) Reduced serum high density lipoprotein (HDL)-cholesterol to ≤1.0mmol/L in men and ≤1.3mmol/L in women; and (5) Elevated fasting glucose level to ≥5.6mmol/L. Data on vascular complications (cerebrovascular, cardiovascular, peripheral vascular disease) and the occurrence of ESRF were retrieved from our cohort database. The association of the MetS with various vascular events, ESRF and mortality was studied by logistic regression models with adjustment for age, sex and the follow-up time since the onset of SLE.
Results 660 SLE patients were studied (93% women; age 45.4±14 years). The mean follow-up time of the patients since the onset of SLE was 12.2±7.8 years. 143 SLE patients were excluded (younger age and shorter disease duration; but no difference in the frequency of SLE manifestations compared with the included patients). The mean body mass index (BMI) of the patients studied was 22.4±4.0kg/m2 (13% >27kg/m2). 97 (15%) of the studied patients qualified the MetS (28% fulfilling waist; 19% fulfilling blood pressure; 27% fulfilling triglyceride; 32% fulfilling HDL and 10% fulfilling glucose criteria). There were a total of 88 arterial vascular events in 77 (11.7%) patients. The most common arterial events were stroke/transient ischemic attack (57%), followed by acute coronary syndrome/angina (27%), peripheral vascular disease (PVD) (12.5%) and arterial thrombosis at other sites (4.5%). 24 (3.6%) patients in our SLE cohort developed ESRF. Separate logistic regression models revealed that the MetS was associated with any arterial events (odds ratio [OR] 2.84 [1.62-5.00]; p<0.001), coronary events (OR 3.41 [1.40-8.30]; p=0.007; PVD and other arterial events (OR 6.09 [1.84-20.1]; p=0.003), adjusted for age, sex and follow-up time. The MetS, however, was not significantly associated with cerebrovascular events (OR 2.00 [0.98-4.06]; p=0.06). The presence of the MetS was associated with mortality (OR 2.27 [1.20-4.28]; p=0.01) and the occurrence of ESRF (OR 5.67 [2.30-14.0]; p<0.001).
Conclusions The MetS, which is a constellation of vascular risk factors, was significantly associated with coronary and peripheral arterial events in patients with SLE. Moreover, the presence of the MetS within 5 years of latest follow-up was associated with mortality and the occurrence of ESRF.
Disclosure of Interest None declared