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Study shows that the inflammatory process associated with systemic lupus erythematosus may contribute to MetS over time.
Almost 40% of people with systemic lupus erythematosus (SLE) may have the constellation of risk factors known as metabolic syndrome (MetS) – adding to their already increased risk of heart disease, according to a multinational cohort study. Two years of follow-up data from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort of 1,150 patients shows a prevalence of MetS ranging from 32.8% and 38.2% -- especially among those with lupus nephritis and active disease. This is the largest study to date examining MetS in SLE, the authors wrote in the study, which was published online in the April 1, 2014 issue of the Annals of Rheumatic Diseases. The article was published as an extended report in the August 2015 online issue of the journal. The SLICC study enrolled recently diagnosed patients from 30 centers in 11 countries, the vast majority of them women with a mean age of 35. “We have previously shown in a cross-sectional analysis of patients with recently diagnosed SLE that MetS occurred in 36.4% of patients,” the authors wrote in the study. “Understanding the interplay between disease activity, therapeutic exposure and MetS in SLE would better inform CHD risk stratification and help guide treatment regimens in higher risk patients.” Overall, MetS was present in 439/1150 (38.2%) at enrolment, 286/823 (34.8%) at year 1 and 243/686 (35.4%) at year 2. The prevalence of MetS varied among racial groups: 35.5%, 32.6% and 31.4% at baseline, year 1 and year 2 for whites; 57%, 38.8% and 62% for blacks; and, 41.7% 29.2% and 32.8% for Koreans. “Our study found that the risk of developing MetS could be determined early in the SLE disease course. This clustering of CHD risk factors and the observed racial/ethnic variation in MetS susceptibility should help inform risk stratification in individual patients and improve the personalized management of early disease,” the authors wrote. The authors suggest that lupus and lupus nephritis, and the SLE inflammatory process, may contribute to MetS over time. It also showed that the use of anti-malarials appeared to be protective against MetS. “Lupus nephritis in very early disease, persistent disease activity and the evolution of damage over time, all significantly influence the development of MetS, which is a persistent phenotype in a substantial number of patients,” they wrote. The authors point to the importance of early identification and treatment to modulate MetS and cardiovascular risk. “From disease onset, therapeutic regimes should aim to rapidly control active disease and should include AMs. Corticosteroid doses should be individually tailored in order to minimize longer term cardiovascular risk, especially in high-risk populations,” the authors concluded. REFERENCES Ian N Bruce, Ben Parker, et al. Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis doi:10.1136/annrheumdis-2013-203933 Abstract