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Insulin resistance implicated in lupus-linked atherosclerosis. (Normal Glucose Maintained).

NEW ORLEANS -- Insulin resistance is linked to the accelerated atherosclerosis that is seen in patients with systemic lupus erythematosus.

In a study that included 27 women who had systemic lupus erythematosus (SLE) and 48 healthy age-matched controls, the SLE patients had significantly higher median fasting insulin values than did the controls (15.6 mU/L versus 10.6 mU/L), Dr. Ian Bruce reported at the annual meeting of the American College of Rheumatology.

The patients did not have diabetes, but they had reduced insulin sensitivity and increased 3-cell function.

"They are able to maintain normal glucose levels because their [beta] cells are working overtime," said Dr. Bruce of the Arthritis Research Campaign, Epidemiology Research Unit, University of Manchester (England).

Twelve patients were taking prednisolone at a median dose of 6.2 mg/day. Long-term corticosteroid therapy is thought to contribute to the development of insulin resistance, but there was no correlation between insulin levels and corticosteroid dose in this cohort of patients, Dr. Bruce said. Studies also have suggested that the dyslipidemia typically associated with lupus-low levels of HDL cholesterol, and high levels of triglycerides-resembles that seen in association with insulin resistance in the general population.

In this group of patients, high fasting insulin levels correlated with high fasting triglycerides, HDL cholesterol, and very-low-density-lipoprotein cholesterol, he said.

Women with lupus are at heightened risk for early coronary artery disease, and traditional risk factors such as obesity, hypertension, and lipid abnormalities do not account for all of the excess risk. But insulin resistance is unlikely to be the sole trigger of early atherosclerosis in SLE. Metabolic, inflammatory, and immunologic factors likely come into play, Dr. Bruce said.

The findings may endorse hydroxychloroquine therapy in preference to steroids. Hydroxychloroquine prolongs the binding of insulin to its receptor, which may extend the action of insulin. Whether this action has an impact on insulin resistance is unclear, he said.
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Author:Walsh, Nancy
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jun 1, 2003
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