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Multicenter Study
. 2021 Oct 2;60(10):4737-4747.
doi: 10.1093/rheumatology/keab090.

Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort

Christine Chew  1 , John A Reynolds  2   3 , Apinya Lertratanakul  4 , Peggy Wu  4 , Murray Urowitz  5 , Dafna D Gladman  5 , Paul R Fortin  6 , Sang-Cheol Bae  7 , Caroline Gordon  3 , Ann E Clarke  8 , Sasha Bernatsky  9 , John G Hanly  10 , David Isenberg  11 , Anisur Rahman  11 , Jorge Sanchez-Guerrero  5 , Juanita Romero-Diaz  12 , Joan Merrill  13 , Daniel Wallace  14 , Ellen Ginzler  15 , Munther Khamashta  16 , Ola Nived  17 , Andreas Jönsen  17 , Kristjan Steinsson  18 , Susan Manzi  19 , Ken Kalunian  20 , Mary Anne Dooley  21 , Michelle Petri  22 , Cynthia Aranow  23 , Ronald van Vollenhoven  24 , Thomas Stoll  25 , Graciela S Alarcón  26 , S Sam Lim  27 , Guillermo Ruiz-Irastorza  28 , Christine A Peschken  29 , Anca D Askanase  30 , Diane L Kamen  31 , Murat İnanç  32 , Rosalind Ramsey-Goldman  4 , Ian N Bruce  33   34
Affiliations
Multicenter Study

Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort

Christine Chew et al. Rheumatology (Oxford). .

Abstract

Objectives: Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance.

Methods: The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10-36 nmol/l), T2 (37-60 nmol/l) and T3 (61-174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels.

Results: Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance.

Conclusions: MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.

Keywords: cardiovascular disease; epidemiology; systemic lupus erythematosus; vitamin D.

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Figures

<sc>Fig</sc>. 1
Fig. 1
25(OH)D levels [mean (IQR)] and sun exposure based on latitude (°N) of patients (***P <0.0001)
<sc>Fig</sc>. 2
Fig. 2
Receiving operating characteristics (ROC) curve analysis for identifying variables predicting the diagnosis of MetS in patients with SLE Renal disease and average glucocorticoid exposure were risk factors associated with MetS in SLE producing an area under the ROC curve (AUC) of 0.6488 (Model). Adding vitamin D to the model improved the AUC to 0.6578 [Model + 25(OH)D].
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