Session Information
Date: Sunday, November 5, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster I: Biomarkers and Outcomes
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Low vitamin D is common in systemic lupus erythematosus (SLE). It is also found in antiphospholipid syndrome. Vitamin D has effects on tissue factor, PAI-1, thrombomodulin and platelet aggregation that suggest it has an anti-thrombotic role. We asked whether low vitamin D was associated with thrombosis in SLE, adjusting for lupus anticoagulant.
Methods: A total of 1,392 SLE patients were included in the analysis. At the first visit when vitamin D was measured, 76.7% had levels of 25-hydroxyvitamin D <40 ng/mL. The SLE patients were: 92% female, mean age 42.9 years, and ethnicity 50% Caucasian, 41% African American. 27% patients had a history of thrombosis; 7% stroke, 4% MI and 14% DVT.
Results: Vitamin D, measured either as a continuous variable or as “low” (<40 ng/mL) vs. normal, was associated with any thrombosis and with DVT.
Table 1: Associations of First Vitamin D Measurement with Thrombosis
|
Positive for Thrombotic Event |
No Thrombotic Event |
P-value |
|||
|
Mean (SD) |
N (%) |
Mean (SD) |
N (%) |
||
|
Any Thrombotic Event |
|||||
|
Vitamin D (ng/ml) (Mean/SD) |
27.6(15.1) |
30.6(14.6) |
0.0008 |
||
|
Vitamin D < 40 ng/ml (N/ %) |
299(80.4) |
759(75.4) |
0.064 |
||
|
Stroke |
|||||
|
Vitamin D (ng/ml) (Mean/SD) |
28.9(15.2) |
29.9(14.7) |
0.5408 |
||
|
Vitamin D < 40 ng/ml (N/ %) |
79(75.2) |
988(76.9) |
0.7914 |
||
|
Myocardial Infarction (MI) |
|||||
|
Mean (SD) |
N (%) |
Mean (SD) |
N (%) |
||
|
Vitamin D (ng/ml) (Mean/SD) |
30.2(16.9) |
29.8(14.7) |
0.883 |
||
|
Vitamin D < 40 ng/ml (N/ %) |
35(70) |
1032(77) |
0.3258 |
||
|
DVT |
|||||
|
Mean (SD) |
N (%) |
Mean (SD) |
N (%) |
||
|
Vitamin D (ng/ml) (Mean/SD) |
25.9(13.4) |
30.4(14.9) |
<0.0001 |
||
|
Vitamin D < 40 ng/ml (N/ %) |
171(87.2) |
895(75) |
0.0002 |
||
We next adjusted for race, age, sex and lupus anticoagulant. Low vitamin D remained associated with DVT.
Table 2 Summary of Adjusted Odds Ratio for Low Vitamin D (< 40 ng/ml)
|
Dependent Variables |
Unadjusted OR (95% CI) |
Adjusted OR (95% CI) |
|
Any Thrombosis |
1.33 (0.99,1.79) |
1.36 (0.99,1.86) |
|
Stroke |
0.91 (0.58,1.45) |
0.92 (0.57,1.48) |
|
MI |
0.7 (0.38,1.29) |
0.8 (0.42,1.53) |
|
DVT |
2.28 (1.47,3.54) |
2.31 (1.47,3.65) |
We next looked prospectively: this analysis excluded thrombotic events before the first vitamin D measurement. It allowed for vitamin D to be a time-varying variable, as replacement therapy was given if it was low. After adjustment for race, age and sex, the adjusted hazard ratio remained significant for any thrombosis: 1.75 (1.04,2.92).
Conclusion: Low vitamin D was significantly associated with any thrombosis and with DVT (even after adjustment for lupus anticoagulant). In prospective models it remained significantly associated with any thrombosis. As supplementation with vitamin D was proven to reduce thrombosis in an oncology randomized clinical trial, vitamin D replacement should become routine in SLE patients at risk for thrombosis.
To cite this abstract in AMA style:
Petri M, Fu W, Goldman D. Low Vitamin D Is Associated with Thrombosis in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/low-vitamin-d-is-associated-with-thrombosis-in-systemic-lupus-erythematosus/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-vitamin-d-is-associated-with-thrombosis-in-systemic-lupus-erythematosus/