AMSTERDAM – Low blood levels of vitamin D were linked with a roughly doubled risk for deep vein thrombosis in a review of nearly 1,400 patients with systemic lupus erythematosus at one U.S. center.
Based on these findings, patients with systemic lupus erythematosus (SLE) should have their blood vitamin D monitored regularly, and if it’s less than 40 ng/mL – the level that was linked with this thrombotic risk – they should receive a vitamin D supplement, Michelle A. Petri, MD, said while presenting a poster at the European Congress of Rheumatology.
She recommended supplementation that provides 50,000 IU of vitamin D weekly, a treatment that appears safe to add to two other routine treatments she recommends for SLE patients – aspirin and hydroxychloroquine.
Dr. Michelle A. Petri
SLE patients should also have their vitamin D level rechecked on a regular basis, perhaps annually, to confirm that their level remains above 40 ng/mL, said Dr. Petri, professor of medicine and director of the Lupus Center at Johns Hopkins Medicine in Baltimore. She acknowledged that this level is above the target level often applied to the general population, but remains safe.
“It looks like vitamin D may be a useful treatment to add to aspirin and hydroxychloroquine in patients with SLE. It looks very simple and important, but this finding should be repeated and validated by other groups,” commented John D. Isaacs, MD, professor of clinical rheumatology at Newcastle University in Newcastle upon Tyne, England.
Dr. Petri and her associates reviewed records for 1,392 SLE patients enrolled in a Johns Hopkins registry. The patients averaged about 43 years old, 92% were women, and 27% had a history of a thrombotic event, either prior to or after their enrollment. The most common thrombotic event was deep vein thrombosis (DVT), in 14%, and also included stroke in 7%, myocardial infarction in 4%, and a smaller number with other types of arterial or venous thromboses. All these patients also had their blood vitamin D level checked at least once, at the time of enrollment, and 77% had a level below 40 ng/mL.
The first analysis looked at the link between any thrombotic event and vitamin D levels, and included adjustment for age, race, sex, and level of lupus anticoagulant. This showed a statistically significant 2.3-fold increased risk for DVT among patients with a vitamin D level of less than 40 ng/mL, compared with those with a higher level. The researchers did not find a significant association between low vitamin D levels and the rates of total thrombotic events or any arterial thrombotic event.
Dr. John D. Isaacs
A second analysis censored out thrombotic events that occurred prior to enrollment and focused on incident thromboses after enrollment into the registry. This analysis showed a statistically significant 75% increased rate of new onset DVT episodes among patients with low vitamin D at entry after adjustment for age, race, and sex. The researchers found no significant associations between low vitamin D and the incidence of any other type of incident thrombosis.
Dr. Petri and Dr. Isaacs reported having no relevant financial disclosures.
SOURCE: Petri MA et al. Ann Rheum Dis. 2018;77(Suppl 2):388, Abstract THU0341.