Background/Purpose: Metabolic syndrome (MetS) is a chronic pro-inflammatory and pro-thrombotic state associated with increased atherosclerosis, cardiovascular events and type 2 diabetes. It is diagnosed in the presence of at least 3 of 5 metabolic risk factors (obesity, hypertension, hypertriglyceridemia, low high-density lipoproteins (HDL) and insulin resistance [1]). The pathophysiology of MetS remains incompletely understood, but may share mechanisms with inflammatory states such as SLE. Visceral adiposity is known as a source of pro-inflammatory cytokines by adipocytes, the so-called adipokines. The contribution of glucocorticoids to the development of MetS in SLE is not clear, even though their use is associated with cardiovascular comorbidities [2]. We aim to characterize the prevalence and associations of MetS, including serum levels of adipokines, in a multi-ethnic cohort of patients with SLE.

Methods: Using a standardised protocol, baseline demographics, per visit disease activity (SLEDAI2K) and treatment data, and annual recording of organ damage accrual (SLICC damage index (SDI)) were prospectively captured on SLE patients from a single tertiary centre. The presence of MetS,defined using the updated joint consensus criteria [1], was assessed retrospectively at the last recorded visit. Serum levels of adipokines (resistin, lipocalin-2, TNF, MCP-1) and insulin were measured by Quantibody.

Results: 116 patients (median (IQR) age at enrolment 39.5 (31.4-51.1) years, median disease duration 6.1 (1.4-12) years) were followed for a median of 6.7 (4.1-8.1) years. 80% of patients were exposed to glucocorticoids (median time-adjusted mean dose 3.7 (0.5-7.0) mg/day and 50% accrued organ damage during follow-up. The prevalence of MetS in this cohort was 29%. The prevalence of the components of MetS included: hypertension (59%), low-HDL (51%), hypertriglyceridemia (32%), obesity (16%) and hyperglycaemia (22%). In univariable analysis, MetS was associated with baseline organ damage (SDI) (OR 4.34; 95% CI 1.80-10.48; P< 0.01) and organ damage accrual (OR 2.34; 1.02-5.36; P=0.04). The association between MetS and baseline organ damage remained significant in multivariable analysis (adjusted OR 3.36; 95% CI 1.32-8.59; P=0.01). Unexpectedly, glucocorticoid use was not associated with MetS or any of its five components. High serum levels of resistin were significantly negatively associated with MetS (OR 0.17; 95% CI 0.04-0.70; P=0.014); no other adipokine were associated with MetS.

Conclusion: MetS is common in SLE patients, with the most frequent components being hypertension and low-HDL. An independent association was found of MetS with baseline organ damage, and low serum resistin, but not glucocorticoid exposure or disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-of-metabolic-syndrome-and-adipokines-in-sle/