25-Hydroxyvitamin D deficiency is associated with increased aortic stiffness in patients with systemic lupus erythematosus

Abstract

Objective. To determine the relationship between serum vitamin D and markers of subclinical cardiovascular disease (CVD) in patients with SLE.Methods. We recruited SLE patients (≥4 ACR 1997 criteria) from outpatient clinics between January 2007 and January 2009. Vitamin D deficiency was defined as serum 25(OH)D <20 ng/ml measured by ELISA. Disease activity was measured using the SLEDAI-2K score. Aortic pulse wave velocity (aPWV) was measured using PulseTrace 3600 (Micromedical) and carotid plaque (CP) and intima–media thickness (IMT) assessed using B-mode Doppler US.Results. Seventy-five women with SLE were recruited with a median (interquartile range) disease duration of 16 (8–27) years. Patients with vitamin D deficiency had higher BMI (P = 0.014) and insulin resistance (P = 0.023) than those with 25(OH)D >20 ng/ml. Subjects with SLEDAI-2K ≥4 had lower 25(OH)D than those with SLEDAI-2K <4 (median 12.9 vs 20.3 ng/ml, P = 0.031). Aortic stiffness was significantly associated with serum 25(OH)D [log(aPWV) β (95% CI) −0.0217 (−0.038, −0.005), P = 0.010] independently of BMI, CVD risk factors and serum insulin. Adjustment for disease activity reduced the strength of the association. There was no association between 25(OH)D and CP or IMT.Conclusions. Vitamin D deficiency is associated with increased aortic stiffness in SLE, independent of CVD risk factors and insulin. Increased inflammatory disease activity may be the mechanism by which vitamin D deficiency mediates vascular stiffness in this patient group.

Association between low 25-hydroxyvitamin D, insulin resistance and arterial stiffness in nondiabetic women with systemic lupus erythematosus

“…15 Complementing these studies, we found that the association between 25(OH) and insulin levels or HOMA-IR in women with SLE was stubbornly maintained after adjustment for BMI. It is noteworthy that the mean BMI in both the Wu et al 16 and Reynolds et al 15 studies were considerably higher ($3 kg/m 2 ) than those that were found in our study. In addition, most patients in the study by Reynolds et al were overweight in contrast with 37% of patients in ours.…”

“…PWV of women with SLE was only 0.5 m/s higher than controls, significantly lower than that described in other studies. 15 The clinical signification of this difference is difficult to assess and we do not have a plausible explanation for this fact. The number of participants included in the study was relatively low and may therefore lack power to identify some correlations (e.g.…”

Update on cardiovascular disease in lupus

“…(106) SLE patients with low vitamin D are at higher risk for CV events,(107, 108) and have increased aortic stiffness. (109, 107**) Treatment with Vitamin D improved myeloid angiogenic cell numbers and function, possibly through downregulation of IP10(110) and regulation of nitric oxide in endothelial cells. (111) A small study suggests Vitamin D repletion may benefit endothelial function in SLE,(112) but large prospective studies are needed to determine the role of Vitamin D supplementation in cardioprotection for SLE.…”

Cardiovascular risk factors, burden of disease and preventive strategies in patients with systemic lupus erythematosus: a literature review

“…Moreover, they were shown to increase CV risk in previously healthy subjects as well as in lupus patients [91]; however, conflicting observations have also been reported [92], thus holding back expectations on vitamin D as a true therapeutic device.…”