Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort

Christine Chew, John A Reynolds, Apinya Lertratanakul, Peggy Wu, Murray Urowitz, Dafna D Gladman, Paul R Fortin, Sang-Cheol Bae, Caroline Gordon, Ann E Clarke, Sasha Bernatsky, John G Hanly, David Isenberg, Anisur Rahman, Jorge Sanchez-Guerrero, Juanita Romero-Diaz, Joan Merrill, Daniel Wallace, Ellen Ginzler, Munther KhamashtaOla Nived, Andreas Jönsen, Kristjan Steinsson, Susan Manzi, Ken Kalunian, Mary Anne Dooley, Michelle Petri, Cynthia Aranow, Ronald van Vollenhoven, Thomas Stoll, Graciela S Alarcón, S Sam Lim, Guillermo Ruiz-Irastorza, Christine A Peschken, Anca D Askanase, Diane L Kamen, Murat İnanç, Rosalind Ramsey-Goldman, Ian N Bruce

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Objectives: Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance.

Methods: The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10–36 nmol/l), T2 (37–60 nmol/l) and T3 (61–174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels.

Results: Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance.

Conclusions: MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.
Original languageEnglish
Article numberkeab090
Pages (from-to)4737-4747
Issue number10
Early online date8 Feb 2021
Publication statusE-pub ahead of print - 8 Feb 2021


  • Pharmacology (medical)
  • Rheumatology


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