Background/Purpose: Pediatric (PED) systemic rheumatic diseases associated with vasculitis (DAV) such as Systemic Lupus Erythematosus (SLE), Mixed Connective Tissue Disease (MCTD) and the various systemic vasculitides (SV) were previously largely fatal but are now chronic diseases (DZ).  However, as adults these patients (pts) appear to have advanced cardiovascular disease (CV) with atherosclerosis that begins in childhood and is impacted by risk factors.  The objective of this study was to evaluate PED pts with DAV for risk factors of CV: diabetes mellitus (DM), impaired glucose tolerance (IGT), and metabolic syndrome (MS).

Methods: A prospective study of 14 PED pts with DAV at a tertiary care children’s hospital.  Each pt had 3 manual blood pressures (BP), a waist circumference, and a physical exam.  After an overnight fast, a 2 hour oral glucose tolerance test (OGTT), fasting insulin level, fasting lipid panel, c-peptide, and hemoglobin A1c (HbA1c) were completed.  Outcome measures included the OGTT, HDL and triglyceride (TG) levels, homeostatic model insulin resistance index (HOMA-IRI) and a diagnosis of MS.  MS was established when 3 of 5 criteria (CR) were met: waist circumference ≥ 90% for age and gender (A&G), high TG ( ≥ 90% A&G), low HDL (≤10% A&G), high BP (systolic or diastolic BP > 90% for height, A&G or taking BP medication), and IGT (OGTT 2-h glucose ≥ 140 mg/dl).  Insulin resistance (IR) was defined as a HOMA-IRI > 3.0.

Results: 14 pts (12F:2M) 11.5 to 16.9 yrs old were included; 10 pts with SLE, 2 with MCTD, 1 with granulomatosis with polyangiitis (GPA/WG), and 1 with microscopic polyangiitis (MPA).  Mean age of DZ onset was 12 yrs with mean DZ duration of 2.6 years.  12/14pts were Latino.  The majority of pts were Tanner (T) 3 – 5 (T3 29%, T4 29%, T5 21%) for pubic hair and T4 – 5 (T4 42%, T5 25%) for breast development.  10 pts had normal BMIs, 1 was < 5%ile, 2 were between 85^th and 95^th %ile, and 1 was > 95^th %ile.  All SLE pts had mild DZ activity by SLE Disease Activity Index (SLEDAI) and both pts with SV had a Birmingham Vasculitis Activity Scale of 1.  All pts had a history of steroid use with 10 pts currently using steroids:  4 (1-5 mg), 2 (6-15 mg), 4 (16-30 mg) daily. 

1 pt met 3 CR for MS (SLE), 2 pts met 2 CR (1 SLE, 1 MCTD), 7 pts met 1 CR (5 SLE, 1 MCTD, 1 SV).  5 (3SLE, 2MCTD) met criteria for HDL, 2 (2SLE) for TG, 5 for BP (3SLE, 1MCTD, 1SV), 1 (SLE) for waist circumference, and 1 (SLE) for IGT.  Pts had a mean HbA1c of 5.3 ±0.25% and none met criteria for DM.  1 pt had a HOMA-IRI >3.0.  5 pts (SLE) had acanthosis nigracans , and 5 (3SLE, 1MCTD, 1SV) had high c-peptide levels (> 3.1 ng/mL).  Of the 5 pts with elevated c-peptide, 3 (2SLE, 1 MCTD) had high fasting insulin (> 10 ulU/mL). 

Conclusion: High rates of elevated c-peptide levels and low HDL levels were seen in PED pts with DAV.  No pts met criteria for DM.  While only 1 pt met formal criteria for MS, IGT, and IR, a majority of pts had components of MS and/or IR.  Higher rates (71.4% vs 40.7%) of pts had ≥1 criteria of MS compared to the general adolescent Mexican-American population in the NHANES III study where a less stringent definition was used for MS (S. Cook et al).  These findings illustrate that CV risk factors are prevalent in PED pts with DAV and screening should be routinely completed.

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluating-cardiovascular-risk-factors-of-impaired-glucose-tolerance-diabetes-mellitus-and-metabolic-syndrome-in-a-primarily-latino-population-with-pediatric-rheumatic-diseases-associated-with-vascu/