SLE Patients at Great Risk for Metabolic Syndrome
The authors studied a cohort of 1,150 patients, finding the occurrence of metabolic syndrome was 38.2% among those with complete data on study enrollment. At 1 year, metabolic syndrome was found in 34.8% of patients, and in 35.4% of patients at year 2. All patients were enrolled within 15 months of being diagnosis with SLE, according to the investigators, who added that the mean disease duration was 24.2 weeks at the time of enrollment, and 90% of participants were female. The team used the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) and the SLICC/ACR Damage Index (SDI) to assess SLE disease activity and damage.
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The authors conducted a complete case analysis of nearly 400 patients with documented metabolic syndrome at all 3 visits, finding 46.6% had the syndrome on at least 1 occasion, while 22.1% demonstrated metabolic syndrome at each visit, and 15.6% developed incident metabolic syndrome over the course of the 2-year follow-up period.
The researchers note that the pervasiveness of metabolic syndrome varied significantly over time based on race or ethnicity. For example, metabolic syndrome occurred in 35.5% of Caucasians at baseline, 32.6% at year 1, and 31.4% at year 2. Meanwhile, prevalence rates among those of African ancestry were 57%, 38.8%, and 62%, respectively, over the same time spans. Among Koreans in the cohort, the syndrome was seen in 41.7% of participants at baseline, 29.2% at year 1, and 32.8% at year 2.
While pointing out that the study was limited by factors such as the fact that some patients—especially those in the highest-risk race and ethnicity groups—were missing metabolic syndrome data, the findings revealed that “patients with SLE have a markedly increased incidence of accelerated atherosclerosis resulting in premature myocardial infarctions, angina, peripheral vascular disease, TIAs, and strokes,” says Murray Urowitz, MD, FRCP(C), professor of medicine at the University of Toronto, and study co-author.
“This accelerated atherosclerosis is contributed to by the classic atherosclerosis risk factors, especially manifested by the metabolic syndrome and the immune inflammatory mechanisms due to the SLE,” adds Urowitz, who is also director of the Centre for Prognosis Studies in the Rheumatic Diseases at Toronto Western Hospital.
“Thus, rheumatologists and primary care physicians must vigorously treat these classic risk factors early in the course of SLE while the disease itself is being treated, in order to help prevent later atherosclerotic disease.”
Parker B, Urowitz, et al. Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis. 2015.