Background The Metabolic Syndrome (MetS) is a disorder of energy utilisation and storage, associated with an increased risk of cardiovascular (CV) disease. MetS may contribute to the increased CV disease in SLE, but the prevalence, cause, and impact of MetS in SLE is poorly understood, as are the effects of glucocorticoid (GC) exposure.
Objectives To characterise the prevalence of the features of MetS in a well-characterised cohort of SLE patients, and determine the effect of GC use on these parameters.
Methods SLE patients studied as part of a single centre prospective longitudinal cohort. Disease activity (SLEDAI-2K), treatment and laboratory details were recorded at each visit. Other investigation results were collected from institution databases. MetS defined as ≥3 criteria1: BMI >30kg/m2; triglycerides>1.7mmol/L; HDL-cholesterol <1.3mmol/L; blood pressure >130/85mmHg or treatment for hypertension; fasting glucose >5.6mmol/L or treatment for hyperglycaemia. Continuous variables were described as median (IQR), and compared using Kruskal-Wallis tests. Categorical variables were described as frequency and compared using Chi-squared tests.
Results289 patients were included (87% female; 51% Caucasian, 29% Asian), and median age at enrolment of 37.7y. Median follow-up was 3.43y (med 15 visits). Time adjusted-mean SLEDAI (AMS) over the study period was 3.67. 81% (211) patients received GC (time-adjusted mean 4.25mg prednisolone/d) and AMS was significantly higher in GC-exposed patients (4.19 vs 1.97 [EM1], p<0.01). MetS criteria were met by 49 (17%) of patients (Table 1). Hypertriglyceridaemia and hypertension were significantly more frequent in GC-treated patients, but the prevalence of obesity and other MetS domains, or MetS overall, were not. There were significantly more patients with MetS score =0 in the GC-exposed subset (43/78 vs 76/211 p<0.01).
The prevalence of obesity of 17% is lower than in the general population. There was no significant change in BMI across the period of observation and surprisingly, no association between GC exposure and change in BMI.
Conclusions The prevalence of MetS in SLE was lower than previously reported in other, smaller, lupus cohorts 2,3. This study suggests GC exposure was associated with hypertriglyceridaemia and hypertension in SLE. Potential negative effects of active disease on MetS domains require further investigation.
Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood; AHA; WHF; International Atherosclerosis Society; International Association for the Study of Obesity. Circ 2009;120(16):1640–45.
Parker B, Ahmad Y, Shelmerdine J, et al. An analysis of the metabolic syndrome phenotype in systemic lupus erythematosus. Lupus 2011;20(14):1459–65.
Chung CP, Avalos I, Oeser A, et al. High prevalence of the metabolic syndrome in patients with systemic lupus erythematosus: association with disease characteristics and cardiovascular risk factors. ARD 2007;66(2):208–14.
Disclosure of Interest None declared
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