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Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease
Veli-Pekka Puurunen1, Antti Kiviniemi1, Samuli Lepojärvi1
1a Research Unit of Internal Medicine , Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland.
Insights
High leptin levels in coronary artery disease (CAD) patients predict major adverse cardiac events (MACE), including heart failure or cardiac death, and acute coronary syndrome or stroke, independent of other risk factors.
Area of Science:
- Cardiology
- Endocrinology
- Biochemistry
Background:
- Leptin, an adipose tissue-derived hormone, is linked to cardiovascular risk factors.
- Understanding leptin's role in coronary artery disease (CAD) is crucial for risk stratification.
Purpose of the Study:
- To investigate whether plasma leptin levels predict major adverse cardiac events (MACE) in patients with established CAD.
Main Methods:
- Fasting plasma leptin was measured in 1946 CAD patients (1327 male, 619 female).
- Patients were followed for two years for primary (MACE: congestive heart failure hospitalization or cardiac death) and secondary (acute coronary syndrome or stroke) endpoints.
Main Results:
- High leptin levels significantly increased the risk of MACE (HR 3.37) and acute coronary syndrome or stroke (HR 1.95) in regression analyses.
- Adding leptin to risk models improved prediction of MACE (increased C-index to 0.81) and patient classification (NRI 0.36).
Conclusions:
- Elevated plasma leptin levels are an independent predictor of short-term adverse cardiac events in CAD patients.
- The potentially detrimental cardiovascular effects of leptin warrant further investigation.
Introduction:
Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.
Methods:
Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke.
Results:
In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64-6.90; p = 0.001) and ACS or stroke (HR 1.95; 95%CI 1.29-2.96; p = 0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71-0.85) to 0.81 (0.74-0.88) and improved classification (NRI 0.36; 95%CI 0.13-0.60; p = 0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001-0.030; p = 0.031).
Conclusions:
High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated. Key messages Leptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors. High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.
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