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Wang XR, Yuan L, Shi R, Li H, Wang DG, Wu YG. Predictors of coronary artery calcification and its association with cardiovascular events in patients with chronic kidney disease. Ren Fail 2021; 43:1172-1179. [PMID: 34315328 PMCID: PMC8330733 DOI: 10.1080/0886022x.2021.1953529] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/21/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the predictors of coronary artery calcification (CAC) and its association with cardiovascular events (CVE) in patients with stage 3-5 chronic kidney disease (CKD). METHOD Two hundred ninety CKD patients in our nephrology department were enrolled from 2018 to May 2019. The levels of matrix Gla protein (MGP) and interleukin 6 (IL-6) were measured via enzyme-linked immunosorbent assay (ELISA) method in 131 CKD patients of all. CAC was evaluated via computed tomography (CT). The covariate factors were analyzed by binary logistic regression analysis. We conducted the visits to explore the prevalence of CVE in 276 CKD patients, and covariate factors were analyzed by Cox proportional hazard model. RESULTS The prevalence of CAC was up to 57.93%. We found that age, diabetes mellitus, hyperphosphatemia, dialysis duration, and the neutrophil-lymphocyte ratio (NLR) were positively associated with CAC in all patients. In 131 patients, we demonstrated that higher IL-6 and lower MGP levels were associated with CAC. A Cox proportional hazard model demonstrated that moderate to severe CAC was correlated with an increased risk for CVE [Hazard Ratio (HR): 7.250; 95% confidence interval (CI): 3.192-16.470], and a higher MGP level was associated with a reduced risk for CVE (HR: 0.340; 95% CI: 0.124-0.933). CONCLUSIONS The prevalence of CAC in patients with CKD is a significant issue. Older age, hyperphosphatemia, dialysis duration, diabetes mellitus, IL-6, and the NLR are associated with CAC. In addition, higher MGP levels represent protective factor for CAC. Moderate to severe CAC, and lower MGP levels are associated with an increased risk for CVE. Abbreviations: AGEs: Advanced glycosylation end products; CAC: Coronary artery calcification; CACS: Coronary artery calcification score; Ca: Calcium; CI: confidence interval; CKD: Chronic kidney disease; CVE: Cardiovascular events; CT: Computed tomography; ELISA: Enzyme-linked immunosorbent assay; Hb: hemoglobin; HR: Hazard ratio; hs-CRP: high-sensitivity C-reactive protein; IL-6: Interleukin 6; iPTH: Intact parathyroid hormone; Mg: Magnesium; MGP: Matrix Gla protein; NF-κB: nuclear factor-kappa gene binding; NRL: Neutrophil-lymphocyte ratio; Runx2: Runt-related transcription factor 2; RRT: Renal replacement therapy; P: Phosphorus; Scr: Serum creatinine; TNF--alpha: Tumor necrosis factor--alpha; TC: Total cholesterol; TG: Triglyceride; VSMC: vascular smooth muscle cel.
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Affiliation(s)
- Xue-rong Wang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, PR China
| | - Liang- Yuan
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, PR China
| | - Rui- Shi
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, PR China
| | - Huan- Li
- Department of Radiology, The Second Hospital of Anhui Medical University, Hefei, PR China
| | - De-guang Wang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, PR China
| | - Yong-gui Wu
- Department of Nephrology, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China
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Arterial calcifications and osteoprotegerin in chronic hemodialysis patients: impact on 6-year survival. Int Urol Nephrol 2021; 54:1135-1143. [PMID: 34505226 DOI: 10.1007/s11255-021-02988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
AIM The association between end-stage renal disease and cardiovascular mortality may be influenced through vascular alterations, in particular atherosclerosis and vascular calcification. The study goal was to assess the impact of each type of arterial intimal calcifications (AIC) and arterial medial calcifications (AMC), of osteoprotegerin (OPG), mineral metabolism markers and other features on all-cause and cardiovascular mortality in chronic hemodialysis patients. METHODS Ultrasound was performed in 87 patients on the carotid and femoral arteries, and the severity of AIC and AMC was assessed calculating a score according to the extension of calcification. We analyzed the link between AIC, AMC, OPG, mineral markers and mortality after 6 years of follow-up. RESULTS The cutoff value for OPG determined using ROC was 4.9 pmol/l for all-cause and cardiovascular mortality. Patients with higher serum OPG levels presented higher mortality rates. Our study revealed that AIC, high OPG, low ankle-arm index, presence of diabetes, smoking status, and lack of arteriovenous fistula are associated with all-cause and cardiovascular mortality in univariate regression analysis. Multivariate analysis identified AIC scoring based on the segmentation method as an independent predictor of all-cause and cardiovascular mortality, along with increased OPG levels. AMC scoring was not a predictor of mortality. CONCLUSIONS Identifying and scoring AIC on ultrasound and measuring OPG levels, as a basis of the HD patient assessment may become valuable tools in clinical work, as these have an impact on death toll.
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Mutual effect modification between adiponectin and HDL as risk factors of cardiovascular events in Type 2 diabetes individuals: a cohort study. Int Urol Nephrol 2021; 53:2583-2591. [PMID: 33674951 DOI: 10.1007/s11255-021-02828-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to assess whether high-density lipoprotein (HDL) cholesterol modifies the association between adiponectin and incident cardiovascular (CV) morbidity and mortality in Type 2 Diabetes Mellitus (T2DM) and vice versa. METHODS At baseline, 106 T2DM participants with various degrees of renal function were enrolled and followed up over a period of 7 years with fatal/nonfatal CV events as outcome. RESULTS During the follow-up, 49 participants experienced incident CV events (28 fatal, 21 nonfatal). On univariate Fine and Gray sub-hazard models, HDL cholesterol was a strong modifier of the association between adiponectin and CV outcomes both on crude (P = 0.011) and gender- and eGFR-adjusted models (P = 0.010). The protective effect for CV events portended by a fixed increase in adiponectin (1 μg/ml) was progressively higher across increasing values of HDL cholesterol. Moreover, plasma adiponectin also modified the protective effect of HDL on CV outcomes both in crude and multivariate analyses. We found a mutual effect modification between adiponectin and HDL as risk factors of CV events in participants with T2DM. CONCLUSION Our results are coherent with the hypothesis that HDL cholesterol might play a pivotal role in the interpretation of the association between adiponectin and the risk of adverse CV outcomes in this population.
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Liu J, Meng Z, Gan L, Guo R, Gao J, Liu C, Zhu D, Liu D, Zhang L, Zhang Z, Xie D, Jiao X, Lau WB, Lopez BL, Christopher TA, Ma X, Cao J, Wang Y. C1q/TNF-related protein 5 contributes to diabetic vascular endothelium dysfunction through promoting Nox-1 signaling. Redox Biol 2020; 34:101476. [PMID: 32122792 PMCID: PMC7327962 DOI: 10.1016/j.redox.2020.101476] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Dysregulated adipokine profiles contribute to the pathogenesis of diabetic cardiovascular complications. Endothelial cell (EC) dysfunction, a common pathological alteration in cardiovascular disorders, is exaggerated in diabetes. However, it is unclear whether and how dysregulated adipokines may contribute to diabetic EC dysfunction. METHODS AND RESULTS Serum C1q/TNF-Related Protein 5 (CTRP5) were determined in control/diabetes patients, and control/diabetic mice (high-fat diet, HFD). We observed for the first time that serum total CTRP5 was increased, high molecular weight (HMW) form was decreased, but the globular form (gCTRP5) was significantly increased in diabetic patients. These pathological alterations were reproduced in diabetic mice. To determine the pathological significance of increased gCTRP5 in diabetes, in vivo, ex vivo and in vitro experiments were performed. Diabetic atherosclerosis and EC dysfunction were significantly attenuated by the in vivo administration of CTRP5 neutralization antibody (CTRP5Ab). EC apoptosis was significantly increased in diabetic EC (isolated from HFD animal aorta) or high glucose high lipid (HGHL) cultured HUVECs. These pathological alterations were further potentiated by gCTRP5 and attenuated by CTRP5Ab. Pathway specific discovery-driven approach revealed that Nox1 expression was one of the signaling molecules commonly activated by HFD, HGHL, and gCTRP5. Treatment with CTRP5Ab reversed HFD-induced Nox1 upregulation. Finally, Nox1siRNA was used to determine the causative role of Nox1 in gCTRP5 induced EC apoptosis in diabetes. Results showed that gCTRP5 activated the mitochondrial apoptotic signal of EC in diabetes, which was blocked by the silencing Nox1 gene. CONCLUSION We demonstrated for the first time that gCTRP5 is a novel molecule contributing to diabetic vascular EC dysfunction through Nox1-mediated mitochondrial apoptosis, suggesting that interventions blocking gCTRP5 may protect diabetic EC function, ultimately attenuate diabetic cardiovascular complications.
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Affiliation(s)
- Jing Liu
- Department of Physiology, Shanxi Medical University, Shanxi, China; Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zhijun Meng
- Department of Physiology, Shanxi Medical University, Shanxi, China; Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lu Gan
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rui Guo
- Department of Physiology, Shanxi Medical University, Shanxi, China
| | - Jia Gao
- Department of Physiology, Shanxi Medical University, Shanxi, China
| | - Caihong Liu
- Department of Physiology, Shanxi Medical University, Shanxi, China
| | - Di Zhu
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Demin Liu
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ling Zhang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zhen Zhang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dina Xie
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Xiangying Jiao
- Department of Physiology, Shanxi Medical University, Shanxi, China
| | - Wayne Bond Lau
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bernard L Lopez
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Xinliang Ma
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jimin Cao
- Department of Physiology, Shanxi Medical University, Shanxi, China.
| | - Yajing Wang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
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Yan Z, Zhao J, Gan L, Zhang Y, Guo R, Cao X, Lau WB, Ma X, Wang Y. CTRP3 is a novel biomarker for diabetic retinopathy and inhibits HGHL-induced VCAM-1 expression in an AMPK-dependent manner. PLoS One 2017. [PMID: 28632765 PMCID: PMC5478095 DOI: 10.1371/journal.pone.0178253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives Diabetic retinopathy (DR) is a severe complication of chronic diabetes. The C1q/TNF-related protein family (CTRPs) has been demonstrated to exert protective effects against obesity and atherosclerosis in animal studies. Heretofore, the association between circulating CTRPs and DR patients has been unexplored. In the current study, we attempt to define this association, as well as the effect of CTRPs upon DR pathophysiology. Design The present investigation is a case control study that enrolled control subjects and type 2 diabetes mellitus (T2DM) patients diagnosed with DR. Serum CTRPs and sVACM-1 were determined by ELISA. Results Serum CTRP3 and CTRP5 levels were markedly decreased in patients with T2DM compared to controls (p<0.05) and inversely associated with T2DM. Furthermore, mutivariate regression and ROC analysis revealed CTRP3 deficiency, not CTRP5, was associated with proliferative diabetic retinopathy (PDR). Spearman’s rank correlation assay demonstrated an inverse association between CTRP3 and sVCAM-1. Finally, exogenous CTRP3 administration attenuated high glucose high lipid (HGHL)-induced VCAM-1 production in an AMPK-dependent manner in cultured human retinal microvascular endothelial cells (HRMECs). Conclusion CTRP3 may serve as a novel biomarker for DR severity. CTRP3 may represent a future novel therapeutic against DR, a common ocular complication of diabetes.
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Affiliation(s)
- Zheyi Yan
- Department of Ophthalmology, The First Affiliated Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Jianli Zhao
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Anesthesiology, The First Affiliated Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lu Gan
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanqing Zhang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Anesthesiology, The First Affiliated Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Guo
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaoming Cao
- Department of Orthopedics, The Second Affiliated Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wayne Bond Lau
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Xin Ma
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yajing Wang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi, China
- * E-mail:
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Ortega Moreno L, Lamacchia O, Salvemini L, De Bonis C, De Cosmo S, Cignarelli M, Trischitta V, Menzaghi C. The paradoxical association of adiponectin with mortality rate in patients with type 2 diabetes: evidence of synergism with kidney function. Atherosclerosis 2016; 245:222-7. [DOI: 10.1016/j.atherosclerosis.2015.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/15/2015] [Accepted: 12/19/2015] [Indexed: 01/02/2023]
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