Background/Purpose:

Vitamin D deficiency is common in SLE. Vitamin D deficiency is also associated with activation of Tissue Factor. In cross-sectional studies, vitamin D deficiency is more common with APS and thrombosis. We determined whether vitamin D deficiency was associated with thrombosis in SLE.

Methods: 1131 SLE patients had a measure of 25-OH vitamin D. Twenty-seven% had a history of any thrombosis, 15% arterial thrombosis (defined as stroke, myocardial infarction, digital gangrene or other arterial thrombosis), and 17% venous thrombosis (defined as DVT or PE, or other venous thrombosis).

Results:

Table 1 shows that low 25-OH vitamin D (<32 ng/ml) was associated with all thrombosis and with venous thrombosis, but not with arterial thrombosis.

               Table 1. Association of 25-OH vitamin D level with thrombosis.

 

Variable	Number (%) with the characteristic Vitamin D <32 (n=667)               Vitamin D ≥32 (n=464)		Adjusted p-value
All thrombosis	199 (30%)	105 (23%)	0.0017*
Arterial thrombosis	107 (16%)	63 (14%)	0.43**
Venous thrombosis	130 (19%)	59 (13%)	0.0004*
Same-day lupus anticoagulant	111 (17%)	62 (14%)	0.089§

*Adjusted for age at last assessment, ethnicity, gender, and history of lupus anticoagulant (LAC).

**Adjusted for age at last assessment, ethnicity, gender, history of LAC, history of hypertension, and history of hypercholesterolemia.

^§Adjusted for age at last assessment, ethnicity, and gender.

Vitamin D deficiency was not associated with any gene signature (interferon, BAFF, neutrophil, or plasma cell).

Conclusion: Vitamin D deficiency in SLE is associated with venous (but not arterial thrombosis) in adjusted analyses that controlled for other risk factors, including lupus anticoagulant. Vitamin D deficiency is not associated with the interferon gene signature. Given that vitamin D deficiency is associated with Tissue Factor expression and that it is already known to be associated with thrombosis in antiphospholipid patients, this is another rationale for vitamin D measurement and supplementation in SLE. Clinical trials, already underway, in the general population may shed further light on the anti-thrombotic potential of vitamin D.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-vitamin-d-is-associated-with-increased-risk-of-venous-thrombosis-in-systemic-lupus-erythematosus-regardless-of-lupus-anticoagulant-status/