Skip to main content

Advertisement

Log in

Prevalence of metabolic syndrome in a cohort of systemic lupus erythematosus patients from Northeastern Brazil: association with disease activity, nephritis, smoking, and age

  • Original Article - Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Systemic lupus erythematosus (SLE), an autoimmune inflammatory disease, is associated with an increased prevalence of accelerated atherosclerosis and cardiovascular events. Metabolic syndrome (MetS) is a set of cardiovascular risk factors in SLE patients, which may lead to a proinflammatory condition and increased morbidity and mortality. The objective of this study was to evaluate the prevalence of MetS in a cohort of SLE patients versus healthy controls, and to analyze the association of clinical and demographic factors. SLE patients (n = 146) treated at a Northeast Brazilian university hospital were evaluated with regard to demographic, clinical, laboratory, and anthropometric parameters and compared to controls (n = 101). MetS was diagnosed according to the definition of 2005 NCEP/ATP III. The average age of SLE patients was 41.7 ± 12.5 years, and 91.8 % were female. MetS was significantly more prevalent in SLE patients (45.2 %) than in controls (32.7 %; p = 0.04). The MetS components such as hypertension, diabetes, and hypertriglyceridemia were significantly more prevalent in SLE. In the univariate analysis, MetS in SLE patients was associated with age, disease duration, Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, smoking, menopause, nephritis, cyclophosphamide use, prednisone dose, and chloroquine use, which appeared to have a protective effect. In the logistic regression analysis, age, disease activity, nephritis, and smoking were statistically significant. The prevalence of MetS observed in our cohort of SLE patients from Northeastern Brazil is higher than controls. MetS components should be routinely investigated to minimize the occurrence of MetS and associated cardiovascular morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al (2005) Diagnosis and management of the metabolic syndrome. An American heart association/national heart, Lung, and blood institute scientific statement. Circulation 112(17):2735–2752

    Article  PubMed  Google Scholar 

  2. Reilly MP, Rader DJ (2003) The metabolic syndrome: more than the sum of its parts? Circulation 108(13):1546–1551

    Article  PubMed  Google Scholar 

  3. Miranda PJ, De-Fronzo RA, Califf RM, Guyton JR (2005) Metabolic syndrome: definition, pathophysiology, and mechanisms. Am Heart J 149(1):33–45

    Article  PubMed  CAS  Google Scholar 

  4. Rask-Madsen C, Dominguez H, Ihlemann N, Hermann T, Kober L, Torp-Pedersen C (2003) Tumor necrosis factor-alpha inhibits insulin´s stimulating effect on glucose uptake and endothelium-dependent vasodilation in humans. Circulation 108(15):1815–1821

    Article  PubMed  CAS  Google Scholar 

  5. El-Magadmi M, Bodill H, Ahmad Y, Durrington PN, Mackness M, Walker M et al (2004) Systemic lupus erythematosus: an independent risk factor for endothelial dysfunction in women. Circulation 110(4):399–404

    Article  PubMed  Google Scholar 

  6. Asanuma Y, Oeser A, Shintani AK, Turner E, Olsen N, Fazio S et al (2003) Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 349(25):2407–2415

    Article  PubMed  CAS  Google Scholar 

  7. Ahmad Y, Shelmerdine J, Bodill H, Lunt M, Pattrick MG, Teh LS et al (2007) Subclinical atherosclerosis in systemic lupus erythematosus (SLE): the relative contribution of classic risk factors and the lupus phenotype. Rheumatology 46(6):983–988

    Article  PubMed  CAS  Google Scholar 

  8. Svenungsson E, Jensen-Urstad K, Heimburger M, Silveira A, Hamsten A, de Faire U et al (2001) Risk factors for cardiovascular disease in systemic lupus erythematosus. Circulation 104(16):1887–1893

    Article  PubMed  CAS  Google Scholar 

  9. Bruce IN, Urowitz MB, Gladman DD, Ibañez D, Steiner G (2003) Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto risk factor study. Arthritis Rheum 48(11):3159–3167

    Article  PubMed  Google Scholar 

  10. Azevedo GZ, Gadelha RG, Vilar MJ (2007) Metabolic syndrome in systemic lupus erythematosus: lower prevalence in Brazil than in the USA. Ann Rheum Dis 66(11):1542

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vadacca M, Margiotta D, Rigon A, Cacciapaglia F, Coppolino G, Amoroso A et al (2009) Adipokines and systemic lupus erythematosus: relationship with metabolic syndrome and cardiovascular disease risk factors. J Rheumatol 36(2):295–297

    Article  PubMed  CAS  Google Scholar 

  12. Bellomio V, Spindler A, Lucero E, Berman A, Sueldo R, Berman H et al (2009) Metabolic syndrome in Argentinean patients with systemic lupus erythematosus. Lupus 18(11):1019–1025

    Article  PubMed  CAS  Google Scholar 

  13. Mok CC, Poon WL, Lai JPS, Wong CK, Chiu SM, Wong CK et al (2010) Metabolic syndrome, endothelial injury, and subclinical atherosclerosis in patients with systemic lupus erythematosus. Scand J Rheumatol 39(1):42–49

    Article  PubMed  CAS  Google Scholar 

  14. Lozovoy MA, Simão AN, Hohmann MS, Simão TN, Barbosa DS, Morimoto HK et al (2011) Inflammatory biomarkers and oxidative stress measurements in patients with systemic lupus erythematosus with or without metabolic syndrome. Lupus 20(13):1356–1364

    Article  PubMed  CAS  Google Scholar 

  15. Sabio JM, Zamora-Pasadas M, Jiménez-Jáimez J, Albadalejo F, Vargas-Hitos J, Rodriguez del Aguila MDM et al (2008) Metabolic syndrome in patients with systemic lupus erythematosus from Southern Spain. Lupus 17(9):849–859

    Article  PubMed  CAS  Google Scholar 

  16. El Magadmi M, Ahmad Y, Turkie W, Yates AP, Sheikh N, Bernstein RM et al (2006) Hyperinsulinemia, insulin resistance, and circulating oxidized low density lipoprotein in women with systemic lupus erythematosus. J Rheumatol 33(1):50–56

    PubMed  Google Scholar 

  17. Negrón AM, Molina MJ, Mayor AM, Rodríguez VE, Vilá LM (2008) Factors associated with metabolic syndrome in patients with systemic lupus erythematosus from Puerto Rico. Lupus 17(4):348–354

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bultink IEM, Turkstra F, Diamant M, Dijkmans BA, Voskuyl AE (2008) Prevalence of and risk factors for the metabolic syndrome in women with systemic lupus erythematosus. Clin Exp Rheumatol 26(1):32–38

    PubMed  CAS  Google Scholar 

  19. Zonana-Nacach A, Santana-Sahagún E, Jiménez-Balderas FJ, Camargo-Coronel A (2008) Prevalence and factors associated with metabolic syndrome in patients with rheumatoid arthritis and systemic lupus erythematosus. J Clin Rheumatol 14(2):74–77

    Article  PubMed  Google Scholar 

  20. Telles RW, Lanna CCD, Ferreira GA, Ribeiro A (2010) Metabolic syndrome in patients with systemic lupus erythematosus: association with traditional risk factors for coronary heart disease and lupus characteristics. Lupus 19(7):803–809

    Article  PubMed  Google Scholar 

  21. Parker B, Urowitz MB, Gladman DD, Lunt M, Bae SC, Sanchez-Guerrero J et al (2013) Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis 72(8):1308–1314

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chung CP, Avalos I, Oeser A, Gebretsadik T, Shintani A, Raggi P et al (2007) High prevalence of the metabolic syndrome in patients with systemic lupus erythematosus: association with disease characteristics and cardiovascular risk factors. Ann Rheum Dis 66(2):208–214

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Parker B, Ahmad Y, Shelmerdine J, Edlin H, Yates AP, Teh LS et al (2011) An analysis of the metabolic syndrome phenotype in systemic lupus erythematosus. Lupus 20(14):1459–1465

    Article  PubMed  CAS  Google Scholar 

  24. Hochberg MC (1997) Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725

    Article  PubMed  CAS  Google Scholar 

  25. Gladmann DD, Ibañez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29(2):288–291

    Google Scholar 

  26. Gladman DD, Ginzler EM, Goldsmith C, Fortin P, Liang M, Urowitz M et al (1996) The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 39(3):363–369

    Article  PubMed  CAS  Google Scholar 

  27. Vidigal FC, Bressan J, Babio N, Salas-Savado J (2013) Prevalence of metabolic syndrome in Brazilian adults: a systematic review. BMC Public Health 13:1198

    Article  Google Scholar 

  28. Gómez M, Ramirez M, Disdier O (2006) Prevalence of the metabolic syndrome among a determined Puerto Rican population. P R Health Sci J 25(2):111–116

    PubMed  Google Scholar 

  29. Baron AD (2002) Insulin resistance and vascular function. J Diabetes Complicat 16(1):92–102

    Article  PubMed  Google Scholar 

  30. Leeuw K, Freire B, Smit AJ, Bootsma H, Kallenberg CG, Bijl M (2006) Traditional and non-traditional risk factors contribute to the development of accelerated atherosclerosis in patients with systemic lupus erythematosus. Lupus 15(10):675–678

    Article  PubMed  Google Scholar 

  31. Bessant R, Duncan R, Ambler G, Swanton J, Isenberg DA, Gordon C et al (2006) Prevalence of conventional and lupus-specific risk factors for cardiovascular disease in patients with systemic lupus erythematosus: a case–control study. Arthritis Rheum 55(6):892–899

    Article  PubMed  CAS  Google Scholar 

  32. Gheita TA, Raafat HA, Sayed S, El-Fishawy H, Nasrallah MM, Abdel-Rasheed E (2013) Metabolic syndrome and insulin resistance comorbidity in systemic lupus erythematosus. Z Rheumatol 72:172–177

    Article  PubMed  CAS  Google Scholar 

  33. Sun K, Liu J, Ning G (2012) Active smoking and risk of metabolic syndrome: a meta-analysis of prospective studies. PLoS One 7(10):e47791

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Mendelsohn ME (2002) Protective effects of estrogen on the cardiovascular system. Am J Cardiol 89(12A):12E–17E

    Article  PubMed  CAS  Google Scholar 

  35. Sabio JM, Vargas-Hitos JA, Navarrete N, Hidalgo-Tenorio C, Jimenes-Alonso J, de las Nieves GLV (2010) Effects of low or medium-dose of prednisone on insulin resistance in patients with systemic lupus erythematosus. Clin Exp Rheumatol 28(4):483–489

    PubMed  CAS  Google Scholar 

  36. Espinola RG, Pierangeli SS, Gharavi AE, Harris EN (2002) Hydroxychloroquine reverses platet activation induced by human IgG antiphospholipid antibodies. Thromb Haemost 87(3):518–522

    PubMed  CAS  Google Scholar 

  37. Petri M, Magder LS (2013) Association between hydroxychloroquine exposure and incidence of diabetes mellitus in systemic lupus erythematosus. Arthritis Rheum 65(S 10):S770

    Google Scholar 

  38. Cairoli E, Rebella M, Danese N, Garra V, Borba EF (2012) Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect. Lupus 21(11):1178–1182

    Article  PubMed  CAS  Google Scholar 

  39. Penn SK, Kao AH, Schott LL, Elliott JR, Toledo FG, Kuller L et al (2010) Hydroxychloroquine and glycemia in women with rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol 37(6):1136–1142

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Grundy SM (2006) Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds. J Am Coll Cardiol 47(6):1093–1100

    Article  PubMed  CAS  Google Scholar 

  41. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SR (2003) The metabolic syndrome: prevalence and associated risk factors findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 163(4):427–436

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dallongeville J, Cottel D, Ferrieres J, Arveiler D, Bingham A, Ruidavets JB et al (2005) Household income is associated with the risk of metabolic syndrome in a sex-specific manner. Diabetes Care 28(2):409–415

    Article  PubMed  Google Scholar 

  43. Marquezine GF, Oliveira CM, Pereira AC, Krieger JE, Mill JG (2008) Metabolic syndrome determinants in na urban population from Brazil: social class and gender-specific interaction. Int J Cardiol 129(2):259–265

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marta Maria das Chagas Medeiros.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Medeiros, M.M.C., Xavier de Oliveira, Í.M. & Ribeiro, Á.T.M. Prevalence of metabolic syndrome in a cohort of systemic lupus erythematosus patients from Northeastern Brazil: association with disease activity, nephritis, smoking, and age. Rheumatol Int 36, 117–124 (2016). https://doi.org/10.1007/s00296-015-3316-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-015-3316-z

Keywords

Navigation