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THU0341 (2018)
Low vitamin d is associated with thrombosis in systemic lupus erythematosus
M. Petri, W. Fu, D.W. Goldman
Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

 

Background: Low vitamin D is common in systemic lupus erythematosus (SLE). It is also found in antiphospholipid syndrome. Vitamin D has effects on tissue factor, PAI-1, thrombomodulin and platelet aggregation that suggest it has an anti-thrombotic role. We asked whether low vitamin D was associated with thrombosis in SLE, adjusting for lupus anticoagulant.

Objectives: We asked whether low vitamin D was associated with thrombosis in SLE, adjusting for lupus anticoagulant.

Methods: A total of 1,392 SLE patients were included in the analysis. At the first visit when vitamin D was measured, 76.7% had levels of 25-hydroxyvitamin D<40 ng/mL. The SLE patients were: 92% female, mean age 42.9 years, and ethnicity 50% Caucasian, 41% African American. 27% patients had a history of thrombosis; 7% stroke, 4% MI and 14% DVT.

Results: Vitamin D, measured either as a continuous variable or as “low” (<40 ng/mL) vs. normal, was associated with any thrombosis and with DVT.

Abstract THU0341 – Table 1 Associations of First Vitamin D Measurement with Thrombosis

Positive for Thrombotic Event

No Thrombotic Event

P-value

Mean (SD)

N (%)

Mean (SD)

N (%)

Any Thrombotic Event

Vitamin D (ng/ml) (Mean/SD)

27.6 (15.1)

30.6 (14.6)

0.0008

Vitamin D<40 ng/ml (N/%)

299 (80.4)

759 (75.4)

0.064

Stroke

Vitamin D (ng/ml) (Mean/SD)

28.9 (15.2)

29.9 (14.7)

0.5408

Vitamin D<40 ng/ml (N/%)

79 (75.2)

988 (76.9)

0.7914

Myocardial Infarction (MI)

Vitamin D (ng/ml) (Mean/SD)

30.2 (16.9)

29.8 (14.7)

0.883

Vitamin D<40 ng/ml (N/%)

35(70)

1032(77)

0.3258

DVT

Vitamin D (ng/ml) (Mean/SD)

25.9 (13.4)

30.4 (14.9)

<0.0001

Vitamin D<40 ng/ml (N/%)

171 (87.2)

895(75)

0.0002
We next adjusted for race, age, sex and lupus anticoagulant. Low vitamin D remained associated with DVT.
Abstract THU0341 – Table 2 Summary of Adjusted Odds Ratio for Low Vitamin D (<40 ng/ml)

Dependent Variables

Unadjusted OR (95% CI)

Adjusted OR (95% CI)

Any Thrombosis

1.33 (0.99,1.79)

1.36 (0.99,1.86)

Stroke

0.91 (0.58,1.45)

0.92 (0.57,1.48)

MI

0.7 (0.38,1.29)

0.8 (0.42,1.53)

DVT

2.28 (1.47,3.54)

2.31 (1.47,3.65)
We next looked prospectively: this analysis excluded thrombotic events before the first vitamin D measurement. It allowed for vitamin D to be a time-varying variable, as replacement therapy was given if it was low. After adjustment for race, age and sex, the adjusted hazard ratio remained significant for any thrombosis: 1.75 (1.04,2.92).

Conclusions: Low vitamin D was significantly associated with any thrombosis and with DVT (even after adjustment for lupus anticoagulant). In prospective models it remained significantly associated with any thrombosis. As supplementation with vitamin D was proven to reduce thrombosis in an oncology randomised clinical trial, vitamin D replacement should become routine in SLE patients at risk for thrombosis.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.1953


Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A388
Session: SLE, Sjögren’s and APS – clinical aspects (other than treatment)