Abstract
Objective
The aim of the present study was to assess the effect of metabolic syndrome (MetS) and insulin resistance comorbidity on the carotid intima-media thickness (IMT) in systemic lupus erythematosus (SLE) patients and their relationship to clinical manifestations, disease activity, and damage.
Methods
The study included 92 SLE patients (mean age 30.18 ± 8.27 years) and 30 matched controls. Disease activity and damage were assessed by the SLEDAI and SLICC indices, respectively. The Health Assessment Questionnaire II (HAQII) and Quality of Life (QoL) index were evaluated in the patients. Levels of insulin, glucose, and creatinine and the lipid profile were measured in patients and controls. Insulin sensitivity was estimated using the homeostatic model assessment index (HOMA-B) for beta cell function and (HOMA-IR) for peripheral tissue insulin resistance. The carotid IMT was measured by ultrasonography.
Results
The SLE patients had high HOMA-IR and HOMA-B. The IMT was significantly increased (0.82± 0.29 mm) compared to the controls (0.45± 0.2 mm).The HOMA-IR, SLEDAI, SLICC, HAQII, and IMT were significantly higher and the QoL lower in those with MetS (n = 34) compared to those without (n = 58), while the HOMAB was comparable. There was a significant correlation between the IMT and the SLEDAI, SLICC, and WHR.
Conclusion
Insulin sensitivity and IMT are altered in SLE patients, especially those with MetS comorbidity with an associated increase in disease activity and damage. Effective management of MetS would help control SLE activity, damage, and the future development of cardiovascular events especially in the absence of symptoms of cardiovascular disease.
Zusammenfassung
Ziel
Ziel der vorliegenden Studie war es, die Wirkung der Komorbidität von metabolischem Syndrom (MetS) und Insulinresistenz auf die Intima-Media-Dicke („intima-media thickness“, IMT) bei Patienten mit systemischem Lupus erythematosus (SLE) und ihren Zusammenhang mit klinischen Symptomen, Krankheitsaktivität und -schäden zu untersuchen
Methoden
In die Studie wurden 92 SLE-Patienten (Durchschnittsalter: 30,18 ± 8,27 Jahre) und 30 entsprechend ausgewählte Kontrollen aufgenommen. Krankheitsaktivität und -schäden wurden anhand der Indizes SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) bzw. SLICC (Systemic Lupus International Collaborating Clinics) bestimmt. Auch der Health Assessment Questionnaire II (HAQII) und der Lebensqualitätsindex (Quality of life, QoL) wurden bei den Patienten erhoben. Insulin-, Glukose und Kreatininwert sowie Lipidprofil wurden bei Patienten und Kontrollen bestimmt. Die Insulinsensitivität wurde anhand der Indizes HOMA-B (Homeostatic Model Assessment Index) für die Betazellfunktion und HOMA-IR für die Insulinresistenz des peripheren Gewebes ermittelt. Die IMT der A. carotis wurde sonographisch gemessen.
Ergebnisse
Die SLE-Patienten wiesen hohe Werte im HOMA-IR und HOMA-B auf. Bei ihnen war die IMT (0,82± 0,29 mm) im Vergleich zu den Kontrollen (0,45± 0,2 mm) deutlich erhöht. HOMA-IR, SLEDAI, SLICC, HAQII und IMT waren bei den Patienten mit MetS (n = 34) signifikant höher und die QoL niedriger als bei denen ohne MetS (n = 58), HOMA-B war dagegen vergleichbar. Zwischen IMT und SLEDAI, SLICC und WHR bestand eine signifikante Korrelation.
Fazit
Insulinsensitivität und IMT sind bei SLE-Patienten verändert, insbesondere bei jenen, bei denen eine MetS-Komorbidität und ein damit einhergehender Anstieg der Krankheitsaktivität und -schäden bestehen. Eine wirksame Therapie des MetS wäre hilfreich bei der Steuerung der SLE-Aktivität, SLE-Schäden und der zukünftigen Entstehung kardiovaskulärer Ereignisse, insbesondere ohne das Vorliegen von Symptomen kardiovaskulärer Erkrankungen.
Similar content being viewed by others
References
Mok CC, Wong RW, Lai KN (2003) Treatment of severe proliferative lupus nephritis: the current state. Ann Rheum Dis 62:799–804
Cervera R, Khamashta MA, Font J et al (2003) Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 82(5):299–308
Roman MJ, Shanker BA, Davis A et al (2003) Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 349(25):2399–2406
Liese AD, Mayer-Davis EJ, Haffner SM (1998) Development of the multiple metabolic syndrome. An epidemiologic perspective. Epidemiol Rev 20:157–172
Bonora E, Formentini G, Calcaterra F et al (2002) HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from the Verona Diabetes Complications Study. Diabetes Care 25(7):1135–1141
Howard G, O’Leary DH, Zaccaro D et al (1996) Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circulation 93(10):1809–1817
Petri M, Spence D, Bone LR, Hochberg MC (1992) Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices. Medicine Baltimore 71:291–302
Petri M, Yoo S-S (1994) Predictors of glucose intolerance in systemic lupus erythematosus [abstract]. Arthritis Rheum 37(Suppl):323
Bruce IN, Urowitz MB, Gladman DD et al (2003) Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study. Arthritis Rheum 48:3159–3167
Sada KE, Yamasaki Y, Maruyama M et al (2006) Altered levels of adipocytokines in association with insulin resistance in patients with systemic lupus erythematosus. J Rheumatol 33(8):1545–1552
Nourooz-zadeh J, Tajaddini-Sarmadi J, McCarthy S et al (1995) Elevated levels of authentic plasma hydroperoxides in NIDDM. Diabetes 44:1054–1058
Berliner JA, Navab M, Fogelman AM et al (1995) Atherosclerosis: basic mechanism of oxidation, inflammation and genetics. Circulation 91:2488–2496
Lopez LR, Salazar-Paramo M, Palafox-Sanchez C et al (2006) Oxidized low-density lipoprotein and β2-glycoprotein I in patients with systemic lupus erythematosus and increased carotid intima-media thickness: implications in autoimmune-mediated atherosclerosis. Lupus 15:80–86
Kobayashi K, Lopez LR, Shoenfeld Y, Matsuura E (2005) The role of innate and adaptive immunity to oxidized low-density lipoprotein in the development of atherosclerosis. Ann N Y Acad Sci 1051:442–454
Zampieri S, Iaccarino L, Ghirardello A et al (2005) Systemic lupus erythematosus, atherosclerosis, and autoantibodies. Ann N Y Acad Sci 1051:351–361
Leuven SI van, Kastelein JJ, D’Cruz DP et al (2006) Atherogenesis in rheumatology. Lupus 15(3):117–121
Bruce IN (2005) ‘Not only…but also’: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford) 44(12):1492–1502
Ryan MJ, McLemore GR, Hendrix ST (2006) Insulin resistance and obesity in a mouse model of systemic lupus erythematosus. Hypertension 48(5):988–993
Bellomio V, Spindler A, Lucero E et al (2009) Metabolic syndrome in Argentinean patients with systemic lupus erythematosus. Lupus 18(11):1019–1025
George J, Harats D, Gilburd B et al (1999) Atherosclerosis-related markers in systemic lupus erythematosus patients: the role of humoral immunity in enhanced atherogenesis. Lupus 8(3):220–226
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum 40:1725
Bombardier C, Gladman DD, Urowitz MB et al (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–640
Gladman D, Ginzler E, Goldsmith C 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 39:363–369
Spitzer WO, Dobson AJ, Hall J et al (1981) Measuring the quality of life of cancer patients. J Chron Dis 34:585–597
Wolfe F, Michaud K, Pincus T (2004) Development and validation of the health assessment questionnaire II: a revised version of the health assessment questionnaire. Arthritis Rheum 50:3296–3305
National Cholesterol Education Program (2001) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults: third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 285:2486–2497
Manzi S, Selzer F, Sutton-Tyrrell K et al (1999) Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum 42(1):51–60
Vlachoyiannopoulos PG, Kanellopoulos PG, Ioannidis JP et al (2003) Atherosclerosis in premenopausal women with antiphospholipid syndrome and systemic lupus erythematosus: a controlled study. Rheumatology 42:645–651
Medina G, Casaos D, Jara LJ et al (2003) Increased carotid artery intima-media thickness may be associated with stroke in primary antiphospholipid syndrome. Ann Rheum Dis 62(7):607–610
Esdaile JM, Abrahamowicz M, Grodzicky T et al (2001) Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 44(10):2331–2337
Doria A, Shoenfeld Y, Wu R et al (2003) Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus. Ann Rheum Dis 62(11):1071–1077
Chung CP, Avalos I, Oeser A 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
Svenungsson E, Jensen-Urstad K, Heimbürger M et al (2001) Risk factors for cardiovascular disease in systemic lupus erythematosus. Circulation 104(16):1887–1893
El Magadmi M, Ahmad Y, Turkie W et al (2006) Hyperinsulinemia, insulin resistance, and circulating oxidized low density lipoprotein in women with systemic lupus erythematosus. J Rheumatol 33(1):50–56
Frostegård J (2002) Autoimmunity: oxidized LDL and cardiovascular disease. Autoimmun Rev 1(4):233–237
McMahona M, Hahna BH (2007) Atherosclerosis and systemic lupus erythematosus: mechanistic basis of the association. Curr Opin Immunol 19(6):633–639
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gheita, T., Raafat, H., Sayed, S. et al. Metabolic syndrome and insulin resistance comorbidity in systemic lupus erythematosus. Z. Rheumatol. 72, 172–177 (2013). https://doi.org/10.1007/s00393-012-1058-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00393-012-1058-9