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 Inanç, Rosalind Ramsey-Goldman, Ian N. Bruce

Research output: Contribution to journalArticlepeer-review


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 (US)
Pages (from-to)4737-4747
Number of pages11
JournalRheumatology (United Kingdom)
Issue number10
StatePublished - Oct 1 2021


  • Cardiovascular disease
  • Epidemiology
  • Systemic lupus erythematosus
  • Vitamin D

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)


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