Plasma leptin levels are associated with coronary atherosclerosis in type 2 diabetes

Leptin signaling may promote atherothrombosis and lead to cardiovascular disease. However, whether leptin is associated with human atherosclerosis, distinct from thrombosis, is unknown. We determined the association of plasma leptin levels with coronary artery calcification (CAC), a measure of coronary atherosclerosis, in a cross-sectional study of type 2 diabetes. Leptin levels were associated with CAC after adjusting for established risk factors [odds ratio (95% confidence interval) for 5 ng/ml leptin increase: 1.31 (1.10-1.55); P = 0.002]. Leptin remained associated with CAC after further controlling for body mass index (BMI) [1.29 (1.07-1.55); P = 0.008], waist circumference [1.30 (1.09-1.57); P = 0.003], C-reactive protein (CRP) levels [1.28 (1.07-1.55); P = 0.008], and subclinical vascular disease [1.30 (1.08-1.57); P = 0.006]. Addition of BMI (P = 0.97), waist (P = 0.55), or CRP (P = 0.39) to a model with leptin failed to improve the model's explanatory power, whereas addition of leptin to a model with BMI (P = 0.029), waist (P = 0.006), or CRP (P = 0.005) improved the model significantly. Plasma leptin levels were associated with CAC in type 2 diabetes after controlling adiposity and CRP. Whether leptin signaling promotes atherosclerosis directly or represents a therapeutic target for the prevention of atherosclerotic cardiovascular disease remains to be explored.     

血浆瘦素水平与冠心病患者冠状动脉病变程度及预后的相关性分析

目的观察接受冠状动脉造影患者的血浆瘦素水平,探讨评价其与冠心病、冠状动脉病变程度及患者临床预后的关系。方法入选住院接受冠状动脉造影的患者116例,男性79例,女性37例,年龄33～82岁,平均(62±11)岁,测定空腹血糖、C反应蛋白、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、纤维蛋白原及血肌酐水平,并立即测定瘦素水平。在冠状动脉造影术后1.5年,对冠心病患者进行门诊或电话随访。所有患者均签署知情同意书。分析瘦素水平与冠心病患者临床预后的关系。结果 116例患者的瘦素水平三分位统计分析后分为低水平组39例(1.032～2.060μg/L)、中水平组39例(2.061～5.299μg/L)、高水平组38例(5.300～40.706μg/L)。相关分析显示冠状动脉病变Gensini积分与血浆瘦素水平呈显著正相关(r=0.23,P=0.012)。80例冠心病患者完成了平均2年的随访,在低、中、高水平瘦素组中,主要不良心脏事件的发生率分别为10.0%、45.8%、65.4%,差异有统计学意义(均为P<0.01),并且这种升高的趋势同样具有统计学意义(P<0.01)。结论瘦素水平与冠心病患者冠状动脉病变程度及不良心脏事件的发生相关。     

Correlation of NLRP3 with severity and prognosis of coronary atherosclerosis in acute coronary syndrome patients

We decided to assess the prognostic value of NLRP3 inflammasome level in acute coronary syndrome (ACS) patients and whether it was related to coronary atherosclerotic severity. Study population included one-hundred and twenty-three (123) subjects. Peripheral blood monocyte NLRP3 protein level was correlated with clinical presentation, angiographic characteristics and its scoring systems as well as GRACE and TIMI risk scores. Follow-up for major adverse cardiac events (MACE) was carried out at 180 days. Peripheral blood monocyte NLRP3 was found to be elevated in ACS patients (P < 0.05) and showed positive correlation with GRACE score (r = 0.619), TIMI score (r = 0.580), SYNTAX score (r = 0.550), Clinical SYNTAX score (r = 0.564) and Gensini score (r = 0.516). NLRP3 was also increased with increasing number of vessels, the number of lesions present and the presence bifurcation lesions (P < 0.05). Multivariate Cox regression analysis showed NLRP3 to be an independent predictor of MACE (P = 0.043). Kaplan–Meier analysis and receiver operating characteristic curves for NLRP3 showed good predictive value for MACE. There is a positive correlation of NLRP3 level with severity of coronary atherosclerosis. NLRP3 level is a promising prognostic utility and is efficient in event prediction for MACE.     

Plasma osteoprotegerin levels and long-term prognosis in patients with intermediate coronary artery lesions

Background:

Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily and plays an important regulatory role in the skeletal, immune, and vascular systems. Intermediate coronary artery lesions that have a diameter stenosis of approximately 20%–70% might cause serious consequences. However, the prognostic value of plasma OPG levels in patients with intermediate coronary artery lesions has been less reported.

Hypothesis:

We hypothesized that OPG is a predictive marker of prognosis of intermediate coronary artery lesions.

Methods:

A prospective study was performed on 890 patients with intermediate (20%–70%) coronary lesions. The median age was 62 years (25th and 75th percentiles, 55 and 70 years, respectively) and 67.2% were male. Fasting blood was sampled at baseline. The primary clinical endpoint was a composite of readmission due to angina pectoris, nonfatal myocardial infarction, revascularization, and cardiovascular death.

Results:

During a median follow‐up of 24 months, events occurred in 11.1% of the patients. Of these patients, 7.9% were readmitted for angina pectoris, 1.5% received revascularization, 0.7% suffered nonfatal myocardial infarction, and 1.0% died. The plasma levels of OPG (median, 5304.7 pg/mL vs 2993.4 pg/mL, P<0.001) and high‐sensitivity C‐reactive protein (median, 4.8 mg/L vs 2.6 mg/L, P<0.001) were higher in patients with events than those without events. After adjusting for traditional risk factors such as age, gender, smoking, hypertension, diabetes, dyslipidemia, high‐density lipoprotein cholesterol, high‐sensitivity C‐reactive protein, percent area stenosis, and drug administration, a multivariate Cox proportional hazard analysis showed that higher OPG levels were an independent predictive factor of the composite clinical endpoint (hazard ratio: 2.49, 95% confidence interval: 1.26–4.89, fourth quartile vs first quartile).

Conclusions:

The higher level of OPG is an independent predictive factor of prognosis in patients with intermediate coronary lesions. © 2011 Wiley Periodicals, Inc. This study was funded by Beijing Municipal Science and Technology Committee (No. D0906006000091). The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

Plasma miRNAs improve the prediction of coronary atherosclerosis in patients with rheumatoid arthritis

Clinical Rheumatology - MicroRNAs (miRNAs) regulate gene expression and are disease biomarkers. Rheumatoid arthritis (RA) patients have accelerated atherosclerosis leading to excess cardiovascular...     

冠心病患者冠状动脉粥样硬化程度与颈动脉粥样硬化的相关性研究

目的 探讨冠心病患者颈动脉粥样硬化与冠状动脉硬化程度之间的关系.方法 选取2012年1月至2013年6月河北大学附属医院心内科治疗的冠心病患者350例,依据冠状动脉造影结果将患者分为冠心病组和非冠心病组,其中冠心病组260例,非冠心病组90例;依据造影结果将冠心病组患者进行再次分组,其中单支病变组113例,双支病变组89例,三支病变组58例.比较冠心病组及非冠心病组间及不同冠状动脉病变支数三组间的颈动脉内-中膜厚度（IMT）、斑块积分及Gensini评分;统计分析冠状动脉病变支数与以上观察指标的相关性.结果 冠心病组的颈动脉IMT、斑块积分、Gensini积分分别为（1.37±0.23）、（5.37±3.98）、（23.32±7.33）,均高于非冠心病组,两组间比较差异有统计学意义（P＜0.05）.双支病变组和三支病变组的斑块检出率为79.8％和81.0％,双支病变组及三支病变组患者颈动脉IMT分别为（1.31±0.21）mm和（1.37±0.27）mm,双支病变组和三支病变组患者的斑块检出率与颈动脉IMT值均高于单支病变组,三组间比较差异有统计学意义（P＜0.05）.冠状动脉病变支数与IMT、颈动脉斑块积分呈显著正相关;Gensini评分与IMT及颈动脉斑块积分呈显著正相关.结论 冠状动脉的粥样硬化程度随着患者的颈动脉粥样硬化程度的升高而加重,冠心病的严重程度可以通过颈动脉超声检测反映出来.     

冠心病患者血浆生长素水平与心功能和预后的相关性研究

目的探讨冠心病患者血浆生长素水平与心功能和预后的关系。方法选择连续入院的冠心病患者83例为冠心病组,按疾病亚型又分为:急性ST段抬高心肌梗死(STEMI)31例,非ST段抬高急性冠状动脉综合征(NSTF-ACS)31例,稳定性心绞痛(SAP)21例。另选25例健康者为对照组。ELISA法检测患者入院1周内生长素水平,并与临床病史、血浆生化指标、心肌损伤标记物水平以及心功能指标进行相关性分析。结果冠心病组患者入院第1天生长素水平明显低于对照组。STEMI患者生长素水平随发病时间逐步升高,但至发病第7天仍未恢复至对照组水平。冠心病患者生长素水平与心肌损伤标记物峰值呈正相关,其中STEMI患者在发病1周内生长素水平与LVEF呈负相关。随访发现STEMI和NSTE-ACS惠者入院第3天,生长素在发生心功能不全和死亡患者中水平更高。结论冠心病患者低水平的生长素可能参与冠状动脉粥样硬化过程;急性心肌梗死后逐步升高的生长素反映了机体的代偿机制,并可能具有预后价值。     

动脉粥样硬化患者血浆apelin水平的变化

目的研究动脉粥样硬化患者血浆apelin水平的变化，并探讨apelin与动脉粥样硬化的关系及可能的影响因素。方法选择动脉粥样硬化患者40例，非动脉粥样硬化对照者30例，用放射免疫法测定两组血浆apelin的水平，并测定两组体重指数（BMI）、腰臀比（WHR）、甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）等指标并进行分析。结果动脉粥样硬化组血浆apelin水平明显高于非动脉粥样硬化对照组，两组间BMI、WHR、TC、LDL有显著性差异。血浆apelin水平与BMI、WHR呈正相关。结论动脉粥样硬化患者血浆apelin水平升高，并与BMI及WHR呈正相关，提示apelin可能参与肥胖相关的动脉粥样硬化的病理生理过程。     

颈动脉粥样硬化与冠状动脉粥样硬化的关系

目的　探讨颈动脉粥样硬化与冠状动脉粥样硬化的关系。方法　对 94例老年患者进行了冠状动脉造影和颈动脉超声检查。颈动脉粥样硬化斑块积分采用Sutton法。结果　单支组及多支组内膜中膜厚度、斑块积分显著高于正常组 ,多支组显著高于单支组 (P<0 .0 5 )。斑块指数与年龄、吸烟、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值、收缩压以及高血压病程的程度呈正相关。结论　颈动脉粥样硬化与冠状动脉粥样硬化的病变是平行的     

Plasma adiponectin levels in relation to prognosis in patients with angiographic coronary artery disease

ObjectiveThe objective was to study the associations between adiponectin levels and cardiovascular adverse clinical outcomes in patients with angiographic coronary artery disease (CAD) within the Han Chinese population in Beijing.Materials/methodsA total of 449 hospitalized patients with angiographic CAD who were Han Chinese in Beijing participated in the study. Plasma adiponectin levels were examined from blood samples using a type of unique enzyme-linked immunosorbent assay that was developed by our laboratory. All of the patients' clinical data, including previously identified cardiovascular risk factors, creatinine clearance and left ventricle ejection fraction, were recorded after admission, and patients were followed up for 19 ± 8 months. The primary end-point was marked by the occurrence of major adverse cardiovascular events (MACE), which included death, targeted vascular revascularization, acute coronary syndrome, heart failure, and transient ischemic attack (TIA) / stroke.ResultsA total of 109 cases of MACE occurred: 15 cases of death, 66 cases of acute coronary syndrome, 4 cases of TIA/stroke, 6 cases of targeted vessel revascularization, and 18 cases of heart failure. Among all the patients, 173 were assigned to the high adiponectin group and 276 were assigned to the low adiponectin group according to their baseline plasma adiponectin levels. The incidence of MACE was significantly higher in the low adiponectin group (P = .037). In a multivariate Cox regression analysis for adiponectin levels, previously documented risk factors, coronary artery stenosis scores, and low adiponectin levels were indicated as independent predictors of MACE in patients with CAD (RR 1.75; 95% CI, 1.066–2.865; P = .027). Further adjustment for hsCRP, Ccr, LVEF, fasting glucose and lipid profile did not attenuate this association (RR = 2.36; 95% CI 1.338–4.167; P = .003). The relative risk for low adiponectin levels after additional adjustment for the coronary score was 2.42 (95% CI 1.367–4.279; P = .002). The Kaplan–Meier survival analysis curve suggested that patients with lower adiponectin concentrations had a decreased event-free survival ratio (log-rank χ² = 4.592, P = .032).ConclusionsThe results indicate a potential association between plasma adiponectin levels and cardiovascular prognosis in patients with CAD.     

Long-term prognosis of medically treated patients with vasospastic angina and no fixed significant coronary atherosclerosis

The clinical course of 48 consecutive patients with vasospastic angina and minor coronary atherosclerosis (no stenoses greater than 50%) was analyzed during an average follow-up period of 47 months. The study group consisted of 37 men and 11 women. Patients were treated with usual doses of calcium antagonists. One patient died (2%) and three had myocardial infarctions (6%). Seventy-one percent were asymptomatic or had infrequent angina; 13% had recurrences but had periods of remission lasting at least 10 months. Only 16% had persistent angina. None of the clinical or angiographic findings at the time of diagnosis were predictive of myocardial infarction or death, and they could not separate angina-free patients from those with recurrences. Thus, vasospastic angina without fixed coronary narrowing has a good prognosis despite the possibility of recurrences. However, there is a slight risk of myocardial infarction and death. This fact should be considered if there are plans to discontinue treatment.     

联合药物治疗在冠状动脉粥样硬化患者治疗过程中的应用状况及疗效观察

目的:探讨在不同冠状动脉狭窄程度的患者中联合药物治疗(CMT)率及其对临床预后的影响。方法:入选我院接受择期冠状动脉造影的患者1 490例,根据造影结果将患者分为:A组(冠状动脉狭窄超过50%,n=716),B组(冠状动脉狭窄50%,n=448)和C组(冠状动脉未见狭窄征象,n=326)。比较患者的CMT率及CMT对预后的影响。随访主要终点为主要不良心血管事件(MACE)定义为死亡、心肌梗死或再次血运重建的复合终点。结果:随着冠状动脉狭窄程度的加重,合并症的发生率逐渐增加,MACE发生率逐渐增加(正常、冠状动脉粥样硬化及冠心病患者分别为0.9%、5.4%和11.0%,P0.001),CMT率逐渐增加(分别为95.1%、98.2%和99.4%,P0.001)。尽管CMT对MACE的影响随冠状动脉狭窄严重程度逐渐减弱(交互作用P=0.038),但在阻塞性冠心病和冠状动脉粥样硬化患者中,CMT均可明显改善患者MACE(冠心病,HR:0.72,95%CI:0.62~0.84,P=0.002;冠状动脉粥样硬化,HR:0.87,95%CI:0.76~0.99,P=0.046)。结论:CMT率在冠状动脉粥样硬化人群中明显低于冠心病人群。尽管在冠状动脉粥样硬化患者CMT对临床预后的影响弱于冠心病患者,但CMT仍是临床预后改善的危险因素。     

Plasma leptin and ghrelin concentrations in patients with Crohn＇s disease

AIM: To determine the concentrations of leptin and ghrelin, which have opposite effects on appetite, energy expenditure, and weight control, in the plasma of patients with Crohn's disease (CD), which is often associated with weight loss and malnutrition. METHODS: Plasma leptin and ghrelin concentrations were determined in 28 outpatients with CD by radioimmunoassay. Age- and sex-matched controls with and without Helicobacter pylori (H pylori) infection (28 for each) were enrolled in the study. Circulating levels of these hormones were assessed with respect to CD activity, disease localization and medical treatment. RESULTS: There were no significant differences in ghrelin levels between CD patients and H pylori -negative controls. However, circulating ghrelin levels were significantly lower in H pylori-infected subjects than in CD patients and uninfected controls. Plasma leptin levels were comparable among the groups. Localization and medication profile had no significant impact on circulating ghrelin and leptin levels. CONCLUSION: Apart from H pylori infection, CD itself has no significant influence on circulating ghrelin and leptin levels in the outpatients who were mostly in inactive state.     

Plasma leptin levels and coronary artery calcification in older adults

CONTEXT: Leptin is associated with adiposity and insulin resistance and may play a direct role in vascular calcification. It is unclear, however, whether leptin is an independent predictor of atherosclerotic burden. OBJECTIVE: The aim of this study was to examine the association between plasma leptin and coronary artery calcification (CAC) in an ethnically diverse cohort of older adult men and women free of clinical cardiovascular disease. DESIGN: This was a cross-sectional study with data collection between January 2002 and February 2004 as part of the ADVANCE Study. SETTING: The study was conducted at an integrated health care delivery system in Northern California. PARTICIPANTS: Participants included 949 men and women aged 60-69 yr old. INTERVENTIONS: There were no interventions. MAIN OUTCOME MEASURE: The main outcome measure was CAC by multidetector row computed tomography. RESULTS: In ordinal logistic regression, plasma leptin levels were positively associated with extent of CAC independently of age, race/ethnicity, and smoking status in women (odds ratio of higher CAC for the sex-specific upper tertile vs. lower tertile = 1.81; 95% confidence interval, 1.10-3.00) but not in men (odds ratio = 1.29; 95% confidence interval = 0.89-1.86). However, this association was explained by metabolic risk factors and adiposity measures. CONCLUSIONS: Our findings support a role of leptin on vascular calcification in women but, in our sample of older adults, the association between leptin and CAC was not independent of other cardiac risk factors.     

Distribution of coronary atherosclerosis in patients with coronary artery disease

The distribution of coronary atherosclerosis has not been fully clarified. We measured coronary artery calcium score (CACS) in 624 consecutive patients for the right coronary artery (RCA), left main trunk (LMT), left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCx), then calculated total CACS. Coronary artery calcium score was measured using the Agatston method. We divided these patients into four groups: CACS 1–100 (Group A, n = 267), CACS 101–400 (Group B, n = 160), CACS 401–1000 (Group C, n = 110), and CACS >1000 (Group D, n = 87). In Group A, B, and C, the CACS in LAD was significantly higher than in the other three arteries (P < 0.0001). In Group D, the CACS was not significantly different between LAD and RCA (P = 0.6930). In Groups A, B, and C, coronary artery calcium (CAC) was more frequently found in LAD compared with other arteries (P < 0.0001). However, in Group D the prevalence of CAC was not significantly different among the three arteries (P = 0.4435). Coronary artery calcium was found more frequently in LAD than in the other coronary arteries in patients with mild to high CAC, but not in those with very high CAC.