Background/Purpose: The Metabolic Score for Insulin Resistance (METS-IR) is a recently developed index proposed as a predictor of cardiovascular (CV) events. In this study, we calculated the METS-IR in patients with systemic lupus erythematosus (SLE), a condition associated with increased CV risk. We assessed its relationship with disease characteristics and CV comorbidities, including disease activity and damage, lipid profile, carotid atherosclerosis, and insulin resistance (IR) indices.

Methods: A total of 308 patients with SLE were enrolled. METS-IR was calculated as previously described: METS-IR = (Ln[(2 × glucose) + triglycerides] × BMI) / Ln(HDL-cholesterol). Disease activity and damage were assessed using the SLEDAI and SDI scores, respectively. Additional evaluations included a full lipid profile, IR indices via HOMA2 (Homeostatic Model Assessment), and carotid ultrasound to measure intima-media thickness and detect carotid plaques. Multivariable linear regression analysis was performed to examine associations between disease characteristics and METS-IR.

Results: METS-IR value in SLE patients was 39.6 ± 10.2. Both waist and hip circumference were significantly and positively associated with METS-IR. Among classical CV risk factors, hypertension was significantly associated with higher METS-IR values, whereas diabetes and smoking were not. No significant associations were observed between METS-IR and disease duration, SLEDAI score, LLDAS or DORIS remission indices, antinuclear antibody profile, or the use of prednisone or other therapies. The SDI damage index showed a significant association with METS-IR in univariable analysis (β = 1.0, 95% CI 0.3–2.0, p = 0.013), but this was not confirmed after adjustment. In contrast, C-reactive protein levels remained positively associated with METS-IR after adjustment for covariates (β = 0.1, 95% CI 0.05–0.2, p = 0.004). Regarding the lipid profile, METS-IR (which includes HDL and triglycerides in its formula) was not significantly associated with serum total cholesterol or LDL-cholesterol levels but showed significant associations with apolipoprotein A1 (β = -0.08, 95% CI -0.1 to -0.07, p < 0.001) and apolipoprotein B (β = 0.04, 95% CI 0.02–0.06, p < 0.001). Although METS-IR does not include insulin or glucose metabolism parameters, both insulin and C-peptide serum levels showed a significant positive association with METS-IR after adjustment. Similarly, HOMA2-IR and beta-cell function indices were also independently and positively associated with METS-IR. In contrast, the presence of carotid plaque and intima-media thickness were not related to METS-IR values. Notably, the SCORE2 CV risk calculator showed a significant positive association with METS-IR (β = 0.4, 95% CI 0.04–0.7, p = 0.030).

Conclusion: In patients with SLE, the METS-IR index is significantly associated with markers of central adiposity, insulin resistance, classical CV risk factors, inflammatory activity, and CV risk estimation, but not with disease activity, accumulated damage, or subclinical carotid atherosclerosis. These findings suggest that METS-IR reflects the metabolic and cardiovascular risk profile in SLE, independently of specific disease characteristics.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-the-metabolic-score-for-insulin-resistance-mets-ir-and-its-associated-factors-in-patients-with-systemic-lupus-erythematosus/