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      Association between hyperleptinemia and cardiovascular outcomes in patients with coronary artery disease

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          Abstract

          Purpose

          Hyperleptinemia has been independently associated with human cardiovascular (CV) diseases. Accordingly, we evaluate the association between serum leptin and future CV events in patients with coronary artery disease (CAD).

          Patients and methods

          This study enrolled 98 patients with CAD from January to December 2012. The primary endpoint included incidences of major adverse CV events and hospitalization. Patients follow-up had been completed on June 30, 2017.

          Results

          After a median follow-up of 52 months, 43 CV events had occurred. Patients with CV events had higher systolic blood pressure ( P = 0.030), total cholesterol ( P = 0.034), C-reactive protein ( P = 0.018), and serum leptin levels ( P = 0.001) than those without CV events. Kaplan–Meier analysis showed greater cumulative incidences of CV events in the high leptin group (median leptin concentration >6.03 ng/mL) than in the low leptin group (log-rank P = 0.012). Multivariate Cox regression analysis showed that triglyceride (HR: 1.010; 95% CI: 1.001–1.018; P = 0.022) and leptin levels (HR: 1.054; 95% CI: 1.026–1.082; P < 0.001) were independently associated with CV events in patients with CAD.

          Conclusion

          Serum leptin levels could serve as a biomarker for future CV events in patients with CAD.

          Most cited references34

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          Plasma leptin: associations with metabolic, inflammatory and haemostatic risk factors for cardiovascular disease.

          Leptin, an adipocyte-derived protein, regulating food intake and metabolism has been implicated in the development of coronary heart disease. We have examined the relationship between leptin and vascular risk factors including insulin resistance, metabolic, inflammatory and haemostatic risk factors. The study was carried out in 3640 non-diabetic men aged 60-79 years drawn from general practices in 24 British towns and who were not on warfarin. Leptin was strongly positively correlated with waist circumference (r=0.58; p<0.0001). Leptin concentrations decreased significantly with increasing physical activity and were lowered in cigarette smokers and elevated in men with pre-existing coronary heart disease and stroke; alcohol intake showed no association with leptin concentration. After adjustment for waist circumference and these lifestyle factors, increased leptin was independently associated with significant increases in insulin resistance, triglycerides, inflammatory markers (interleukin-6, C-reactive protein, fibrinogen, plasma viscosity), coagulation factor VIII, endothelial markers von Willebrand factor, tissue plasminogen activator, and fibrin D-dimer levels; and a decrease in HDL-cholesterol. No association was seen between leptin and blood pressure, total cholesterol, glucose or white cell count after adjusting for waist circumference. Further adjustment for insulin resistance abolished the relationships between leptin and triglycerides and HDL-cholesterol, weakened the associations with the haemostatic factors although they remained significant, but made minor differences to the associations with inflammatory markers. Plasma leptin is associated with insulin resistance, inflammation and disturbances in haemostasis independent of waist circumference, suggesting possible pathways by which leptin may influence risk of cardiovascular disease.
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            The obesity-associated peptide leptin induces hypertrophy in neonatal rat ventricular myocytes.

            One of the major manifestations of obesity is increased production of the adipocyte-derived 16-kDa peptide leptin, which is also elevated in heart disease, including congestive heart failure. However, whether leptin can directly alter the cardiac phenotype is not known. We therefore studied the effect of leptin as a potential hypertrophic factor in cultured myocytes from 1- to 4-day-old neonatal rat heart ventricles. Using RT-PCR, we demonstrate that these cells express the short-form (OB-Ra) leptin receptor. Twenty-four hours of exposure to leptin (0.31 to 31.3 nmol/L) produces a significantly increased cell surface area that peaked at 0.63 nmol/L. Subsequent experiments were done with 3.1 nmol/L leptin, which significantly increased cell area by 42%, protein synthesis by 32%, and alpha-skeletal actin and myosin light chain-2 expression by 250% and 300%, respectively. These events occurred in the absence of any increased cell death. Hypertrophy was preceded by rapid activation of the mitogen-activated protein kinase system including p38 and p44/42 as early as 5 minutes after leptin addition, whereas hypertrophy was inhibited by the p38 inhibitor SB203580 but not by the p44/42 inhibitor PD98059. Our results demonstrate a direct hypertrophic effect of leptin and may offer a biological link between hypertrophy and hyperleptinemic conditions such as obesity.
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              Leptin stimulates rat aortic smooth muscle cell proliferation and migration.

              Leptin, a peptide secreted from adipose tissue, plays an important role in the regulation of food intake and energy expenditure. In obese patients, plasma leptin levels are elevated and obesity is one of the major risk factors for cardiovascular diseases. Therefore, in this study, we investigated the effect of leptin on vascular smooth muscle cell (VSMC) functions. Cultured rat aortic VSMC expressed 130-kDa short form of leptin receptor. Leptin stimulated both proliferation and migration of VSMC. Leptin stimulated phosphorylation and activation of mitogen-activated protein (MAP) kinases, and also increased phosphatidylinositol (PI) 3-kinase activity. Further, two distinct PI 3-kinase inhibitors, wortmannin and LY294002 inhibited the migratory effect of leptin. These results demonstrate that leptin is a proliferative and migratory factor for VSMC, implying that leptin may play a role in the formation and development of vascular lesions.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                01 October 2018
                : 14
                : 1855-1862
                Affiliations
                [1 ]Department of Pediatrics
                [2 ]Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
                [3 ]School of Medicine, Tzu Chi University, Hualien, Taiwan, gee.lily@ 123456msa.hinet.net
                [4 ]Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
                [5 ]Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, gee.lily@ 123456msa.hinet.net
                Author notes
                Correspondence: Bang-Gee Hsu, Division of Nephrology, Buddhist Tzu Chi General Hospital, No 707, Section 3, Chung-Yang Road, Hualien, Taiwan, Tel +886 3 856 1825, Fax +886 3 857 7161, Email gee.lily@ 123456msa.hinet.net
                [*]

                These authors contributed equally to this work

                Article
                tcrm-14-1855
                10.2147/TCRM.S172231
                6171750
                49b18e43-e16b-4f85-8dde-9fb7c9bae6d6
                © 2018 Chen et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Medicine
                leptin,coronary artery disease,cardiovascular events,triglyceride
                Medicine
                leptin, coronary artery disease, cardiovascular events, triglyceride

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