BIRMINGHAM, ENGLAND – Lupus patients are most likely to have the metabolic syndrome early in the course of their disease if they have had the syndrome in the past, data from a large, prospective, observational study have shown.
The odds ratio (OR) for prior metabolic syndrome and having the syndrome in the first 2 years of follow-up was 4.83 in patients recently diagnosed with lupus (less than 15 months).
Hispanic ethnicity (OR, 3.47), elevated anti-dsDNA antibodies (OR, 1.86), age (OR, 1.03), and the use of a high peak prednisolone dose (40 mg) at enrollment (OR, 1.02) were also found to increase the risk for the metabolic syndrome early in the course of the disease.
Dr. Ben Parker
Patients with systemic lupus erythematosus (SLE) are known to have an increased risk for the metabolic syndrome (Rheum. Dis. Clin. North Am. 2010;36:81-97), and this may contribute to increased cardiovascular risk and subsequent mortality, observed Dr. Ben Parker, a clinical research fellow at the Arthritis UK Epidemiology Unit, University of Manchester, England.
"It is fairly well established that SLE is an independent risk factor for cardiovascular disease," Dr. Parker said at the British Society for Rheumatology annual conference.
The mechanism of cardiovascular risk in SLE is not known, but it is likely to be "very complex and multifactorial," Dr. Parker added. "It is certainly related to ‘classic’ [cardiovascular] risk factors, systemic inflammation, some disease-specific risk factors, and the therapeutic exposures," he said.
Previously, Dr. Parker and his associates have shown that renal lupus, higher daily prednisolone doses, and being of Korean or Hispanic ethnicity are associated with the presence of the metabolic syndrome in SLE (Ann. Rheum. Dis. 2012 Sept. 3 [doi: 10.1136/annrheumdis-2012-202106]).
Their current investigation used data from the SLICC-RAS (Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis) study, a prospective, observational study initiated in 2000 that involves 30 centers in 11 countries in North America, Europe, and Asia. The aim was to identify factors that were associated with the metabolic syndrome during the first 2 years of follow-up.
A total of 1,494 of 1,686 patients with SLE who were diagnosed within the past 15 months in SLICC-RAS had sufficient data to determine their metabolic syndrome status and were included in the analysis. The mean age of patients at enrollment was 35.2 years, and the mean disease duration was 5.5 months.
The prevalence of the metabolic syndrome was 16% (n = 1,494) at enrollment, 12.6% (n = 1,065) at 1 year’s follow-up, and 13.6% (n = 895) at the 2-year follow-up assessment. Metabolic syndrome was defined according to International Diabetes Federation criteria, which require at least three of the following five factors to be present: obesity, hypertension, hypertriglyceridemia, low HDL cholesterol, and insulin resistance (Circulation 2009;120:1640-5).
There was fluctuation in metabolic status in the first 2 years of follow-up. Of 720 patients who had attended all three (enrollment, 1-year, and 2-year) assessments, 26.9% had the metabolic syndrome at any time during the first 2 years of follow-up, with 4.3% having the metabolic syndrome at all three assessments, 7.4% at two, and 15.3% at one.
"Around 73.1% of patients did not get the metabolic syndrome at all, and 14% developed it over the first 2 years," Dr. Parker reported. "Prevalent metabolic syndrome strongly predicts ongoing metabolic syndrome," he added.
A high corticosteroid dose at enrollment also increased the risk for the metabolic syndrome, Dr. Parker observed. The peak, daily dose of prednisolone used at enrollment was 40 mg, which decreased to 24.2 mg at the 1-year and 16.2 mg at the 2-year follow-up assessment. The respective average corticosteroid doses used were 20, 12.6, and 9.8 mg.
Dr. Parker concluded that the study data support a more personalized approach to managing patients with early, active SLE "in an attempt to rapidly and effectively control disease while trying to reduce corticosteroid doses," he said. The overall aim is to improve the cardiovascular risk profile for patients over time.
Arthritis Research UK funded the study. Dr. Parker had no conflicts of interest.