Global prevalence and associated factors of metabolic syndrome in patients with systemic lupus erythematosus: A systematic review and meta-analysis

Authors

• Sandeep Samethadka Nayak, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
• Shahriar Ghodous, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• Narsimha Rao Keetha, Ohio Kidney and Hypertension Center, Middleburg Hts, OH, USA.
• Anoop Gurram, Department of Hospital Medicine Cleveland Clinic, OH, USA.
• Negin Letafatkar, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• Prashant Ahlawat, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
• Arman Habibi, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• Srinivasa Ramanujan Boora, Pennstate Health Holy Spirit Hospital, Camp Hill, PA, USA.
• Seyed Mohammad Hashemi, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
• Sivaramakrishna Cheetirala, Advocate Health - MidwestFollow
• Mohammad Amouzadeh-Lichahi, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• Sarpong Boateng, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
• Maryam Jafari, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• Madhu Ponnala, Pennstate Health Holy Spirit Hospital, Camp Hill, PA, USA.
• Asal Khorami, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
• Simran Joshi, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
• Ilya Saberi, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• AmirAli Moodi Ghalibaf, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
• Antony Arumairaj, Division of Hospital Medicine Department of Internal Medicine Woodhull Medical Center, NYU Langone760 Broadway Brooklyn, NY 11206, USA.
• Ehsan Amini-Salehi, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
• Nishant Sharma, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.

Recommended Citation

Samethadka Nayak S, Ghodous S, Keetha NR, et al. Global prevalence and associated factors of metabolic syndrome in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Lupus. 2026;35(13):1354-1381. doi:10.1177/09612033261477274

Abstract

Background: Systemic lupus erythematosus (SLE) is characterized by chronic systemic inflammation, frequent corticosteroid exposure, and heightened cardiometabolic vulnerability. Metabolic syndrome (MetS) has become a clinically significant comorbidity among individuals with SLE. We performed an updated systematic review and meta-analysis to better understand the prevalence and identify the factors associated with the occurrence of MetS in SLE.

Methods: PubMed, Scopus, and Web of Science were systematically searched through January 4, 2026 to identify observational studies reporting the prevalence of MetS among individuals with SLE. Random-effects meta-analytic models were applied to calculate pooled prevalence estimates and evaluate the associations with potential risk factors.

Results: The overall pooled prevalence of MetS in patients with SLE was estimated at 0.27 (95% CI: 0.24-0.30). Sex-stratified analyses showed a prevalence of 0.36 (95% CI: 0.25-0.47) in male patients and 0.27 (95% CI: 0.23-0.30) in female patients. Across continents, the highest prevalence was observed in Africa (0.36, 95% CI: 0.30-0.41), followed by South America (0.32, 95% CI: 0.24-0.40), Asia (0.27, 95% CI: 0.22-0.32), Europe (0.23, 95% CI: 0.18-0.28), and North America (0.21, 95% CI: 0.14-0.30). Regarding medication use, hydroxychloroquine was associated with a significantly reduced risk of MetS (OR = 0.66, 95% CI: 0.52-0.83; P < 0.01), whereas cyclophosphamide (OR = 1.39, 95% CI: 1.06-1.81; P = 0.02), azathioprine (OR = 1.25, 95% CI: 1.00-1.55; P = 0.04), and mycophenolate mofetil (OR = 1.13, 95% CI: 1.03-1.23; P = 0.01) were each associated with a significant increased risk of MetS. No significant associations were found for steroids (OR = 1.34, 95% CI: 0.97-1.83; P = 0.07), methotrexate (OR = 1.07, 95% CI: 0.78-1.47; P = 0.84), or cyclosporine use (OR = 1.19, 95% CI: 0.64-2.21; P = 0.33). The analysis also identified several risk factors for MetS in SLE patients. Patients with MetS were older (Hedges' g = 0.47; P < 0.01), had higher BMI (Hedges' g = 0.88; P < 0.01), and higher total cholesterol (Hedges' g = 0.39; P < 0.01) and LDL levels (Hedges' g = 0.41; P < 0.01) than those without MetS.

Conclusion: MetS is prevalent among individuals with SLE and is influenced by demographic, clinical, and treatment-related factors. These findings highlight the need for targeted monitoring and management strategies to reduce the cardiometabolic risk in this population.

Document Type

Article

PubMed ID

42712258