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Roy N, Haddad D, Yang W, Rosas SE. Adipokines and coronary artery calcification in incident dialysis participants. Endocrine 2022; 77:272-280. [PMID: 35751773 DOI: 10.1007/s12020-022-03111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Adipokines have been associated with increased risk of cardiovascular disease. Our aim was to determine if adipokine levels are associated with coronary artery calcification (CAC) as well as all-cause mortality in incident dialysis patients. METHODS In patients new to dialysis, we prospectively investigated the association of adiponectin, leptin and resistin with coronary artery calcification measured by ECG-gated computer tomography. Participants were recruited a median of two months after starting dialysis. RESULTS The mean age was 50.0 (12.6) years and 31.1% were women. About 42% percent had BMI > 30. Higher adiponectin levels were inversely associated with CAC progression as change in Agatston score [-155.1 (-267.9, -42.2), p = 0.008] or change in CAC volumes between scans [-2.8 (-4.9, -0.6), p = 0.01]. Higher leptin levels were associated with CAC progression [110.4 (34.3-186.6), p = 0.005]. Decreased leptin [HR 0.5 (0.3-0.9), p = 0.05] was associated with all-cause mortality in adjusted models. There was no significant association between all-cause mortality and adiponectin [1.4 (0.6-3.4), p = 0.4] or resistin [HR 1.7 (0.5-5.0), p = 0.4]. CONCLUSION High adiponectin protects against CAC progression, but is not associated with increased all-cause mortality. Higher leptin, as well as higher leptin to adiponectin ratio, is associated with CAC progression. Lower leptin levels were associated with all-cause mortality. The association of adipokines and cardiovascular disease in individuals on dialysis is complex and requires further study.
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Affiliation(s)
- Neil Roy
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Danny Haddad
- RWJ Barnabas -Jersey City Medical Center, Jersey City, NJ, USA
| | - Wei Yang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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2
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Role of Uremic Toxins in Early Vascular Ageing and Calcification. Toxins (Basel) 2021; 13:toxins13010026. [PMID: 33401534 PMCID: PMC7824162 DOI: 10.3390/toxins13010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022] Open
Abstract
In patients with advanced chronic kidney disease (CKD), the accumulation of uremic toxins, caused by a combination of decreased excretion secondary to reduced kidney function and increased generation secondary to aberrant expression of metabolite genes, interferes with different biological functions of cells and organs, contributing to a state of chronic inflammation and other adverse biologic effects that may cause tissue damage. Several uremic toxins have been implicated in severe vascular smooth muscle cells (VSMCs) changes and other alterations leading to vascular calcification (VC) and early vascular ageing (EVA). The above mentioned are predominant clinical features of patients with CKD, contributing to their exceptionally high cardiovascular mortality. Herein, we present an update on pathophysiological processes and mediators underlying VC and EVA induced by uremic toxins. Moreover, we discuss their clinical impact, and possible therapeutic targets aiming at preventing or ameliorating the harmful effects of uremic toxins on the vasculature.
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Rapp N, Evenepoel P, Stenvinkel P, Schurgers L. Uremic Toxins and Vascular Calcification-Missing the Forest for All the Trees. Toxins (Basel) 2020; 12:E624. [PMID: 33003628 PMCID: PMC7599869 DOI: 10.3390/toxins12100624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 12/23/2022] Open
Abstract
The cardiorenal syndrome relates to the detrimental interplay between the vascular system and the kidney. The uremic milieu induced by reduced kidney function alters the phenotype of vascular smooth muscle cells (VSMC) and promotes vascular calcification, a condition which is strongly linked to cardiovascular morbidity and mortality. Biological mechanisms involved include generation of reactive oxygen species, inflammation and accelerated senescence. A better understanding of the vasotoxic effects of uremic retention molecules may reveal novel avenues to reduce vascular calcification in CKD. The present review aims to present a state of the art on the role of uremic toxins in pathogenesis of vascular calcification. Evidence, so far, is fragmentary and limited with only a few uremic toxins being investigated, often by a single group of investigators. Experimental heterogeneity furthermore hampers comparison. There is a clear need for a concerted action harmonizing and standardizing experimental protocols and combining efforts of basic and clinical researchers to solve the complex puzzle of uremic vascular calcification.
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MESH Headings
- Animals
- Cardio-Renal Syndrome/metabolism
- Cardio-Renal Syndrome/pathology
- Cardio-Renal Syndrome/physiopathology
- Cardio-Renal Syndrome/therapy
- Humans
- Kidney/metabolism
- Kidney/pathology
- Kidney/physiopathology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Prognosis
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/pathology
- Renal Insufficiency, Chronic/physiopathology
- Renal Insufficiency, Chronic/therapy
- Toxins, Biological/metabolism
- Uremia/metabolism
- Uremia/pathology
- Uremia/physiopathology
- Uremia/therapy
- Vascular Calcification/metabolism
- Vascular Calcification/pathology
- Vascular Calcification/physiopathology
- Vascular Calcification/therapy
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Affiliation(s)
- Nikolas Rapp
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Pieter Evenepoel
- Laboratory of Nephrology, KU Leuven Department of Microbiology and Immunology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Peter Stenvinkel
- Karolinska Institute, Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, 141 86 Stockholm, Sweden;
| | - Leon Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands;
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4
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Liu D, Chen L, Dong S, Yang H, Li L, Liu J, Zhou H, Zhou R. Low bone mass is associated with carotid calcification plaque in Chinese postmenopausal women: the Chongqing osteoporosis study. Climacteric 2019; 23:237-244. [PMID: 31612731 DOI: 10.1080/13697137.2019.1671818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The aim of this study was to examine the relationship between low bone mass and the risk of carotid calcification plaques in Chinese postmenopausal women.Methods: We conducted a 5 years prospective study. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) scanning. Carotid computed tomography angiography (CTA) was conducted using a 64-multidetector row scanner to assess carotid arterial plaque at baseline and during follow-up. Cox proportional hazards analysis was used to evaluate the association of BMD and risk of carotid calcification plaques.Results: Four hundred and eighty-eight women sustained prospective carotid plaques during the follow-up. Women with carotid calcification plaques had low BMD than those with carotid non-calcification plaques. After adjustment for potential confounders, BMD, age, years since menopause, levels of plasma osteoprotegerin and adiponectin, hypertension, diabetes mellitus and hyperlipidemia were independently associated with increased risk of carotid calcification plaques. For carotid calcification plaques, a significant inverse correlation was indicated between BMD and the plaques, and a significant positive correlation was indicated between bone loss and plaques.Conclusions: This study suggested that lower BMD and increased loss rate of BMD were associated with a higher risk of carotid calcification plaques in Chinese postmenopausal women.
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Affiliation(s)
- D Liu
- Trauma Center, Daping Hospital, Army Medical University, Chongqing, China
| | - L Chen
- Postgraduate School, Bengbu Medical College, Anhui, China
| | - S Dong
- Postgraduate School, Bengbu Medical College, Anhui, China
| | - H Yang
- Department of Neurology, Daping hospital, Army Medical University, Chongqing, China
| | - L Li
- Department of Neurology, Daping hospital, Army Medical University, Chongqing, China
| | - J Liu
- Department of Neurology, Daping hospital, Army Medical University, Chongqing, China
| | - H Zhou
- Department of Neurology, Daping hospital, Army Medical University, Chongqing, China
| | - R Zhou
- Department of Orthopedics, The Orthopedic Surgery Center of Chinese PLA, Southwest Hospital, Army Medical University, Chongqing, China
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5
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Rodriguez M, Aguilera-Tejero E. Energy-Dense Diets and Mineral Metabolism in the Context of Chronic Kidney Disease⁻Metabolic Bone Disease (CKD-MBD). Nutrients 2018; 10:nu10121840. [PMID: 30513703 PMCID: PMC6315996 DOI: 10.3390/nu10121840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of this paper is to review current knowledge about the interactions of energy-dense diets and mineral metabolism in the context of chronic kidney disease–metabolic bone disease (CKD-MBD). Energy dense-diets promote obesity and type II diabetes, two well-known causes of CKD. Conversely, these diets may help to prevent weight loss, which is associated with increased mortality in advanced CKD patients. Recent evidence indicates that, in addition to its nephrotoxic potential, energy-dense food promotes changes in mineral metabolism that are clearly detrimental in the context of CKD-MBD, such as phosphorus (P) retention, increased concentrations of fibroblast growth factor 23, decreased levels of renal klotho, and reduction in circulating concentrations of calcitriol. Moreover, in uremic animals, a high fat diet induces oxidative stress that potentiates high P-induced vascular calcification, and these extraskeletal calcifications can be ameliorated by oral supplementation of vitamin E. In conclusion, although energy-dense foods may have a role in preventing undernutrition and weight loss in a small section of the CKD population, in general, they should be discouraged in patients with renal disease, due to their impact on P load and oxidative stress.
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Affiliation(s)
- Mariano Rodriguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain.
| | - Escolastico Aguilera-Tejero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain.
- Department Medicina y Cirugia Animal, University of Cordoba, 14071 Cordoba, Spain.
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Szulc P, Amri EZ, Varennes A, Panaia-Ferrari P, Fontas E, Goudable J, Chapurlat R, Breuil V. Positive Association of High Leptin Level and Abdominal Aortic Calcification in Men - The Prospective MINOS Study. Circ J 2018; 82:2954-2961. [PMID: 30282882 DOI: 10.1253/circj.cj-18-0517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Severe abdominal aortic calcification (AAC) points to high cardiovascular risk and leptin stimulates arterial calcification; however, clinical data on their association are scarce. We studied the link between serum leptin and AAC severity and progression, and the effect of smoking and lipid levels, on this association in men. Methods and Results: At baseline, 548 community-dwelling men aged 50-85 years underwent blood collection and lateral lumbar spine radiography. In 448 men, X-ray was repeated after 3 and 7.5 years. AAC was assessed using Kauppila's semiquantitative score. In multivariable models, high leptin was associated with higher odds of severe AAC (odds ratio [OR]=1.71 per SD, 95% confidence interval [CI]: 1.22-2.40). The odds of severe AAC were the highest in men who had elevated leptin levels and either were ever-smokers (OR=9.22, 95% CI: 3.43-24.78) or had hypertriglyceridemia (vs. men without these characteristics). Higher leptin was associated with greater AAC progression (OR=1.34 per SD, 95% CI: 1.04-1.74). The risk of AAC progression was the highest in men who had elevated leptin levels and either were current smokers or had high low-density lipoprotein-cholesterol levels (OR=5.91, 95% CI: 2.46-14.16 vs. men without these characteristics). These links remained significant after adjustment for baseline AAC and in subgroups defined according to smoking and low-density lipoprotein-cholesterol levels. CONCLUSIONS In older men, high leptin levels are associated with greater severity and rapid progression of AAC independent of smoking, low-density lipoprotein-cholesterol or triglycerides.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR1033, University of Lyon, Hospices Civils de Lyon
| | - Ez Zoubir Amri
- CNRS, iBV UMR 7277, Nice Sophia Antipolis University.,INSERM, iBV U1091
| | - Annie Varennes
- Laboratory of Medical Biology, Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon
| | | | - Eric Fontas
- Department of Clinical Research, Cimiez Hospital, Nice University Hospital
| | - Joëlle Goudable
- Department of Public Health, University of Lyon, Hospices Civils de Lyon
| | | | - Véronique Breuil
- Department of Rheumatology, Medical Faculty, Pasteur Hospital, Nice University Hospital, Université Nice Sophia Antipolis
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Mehta A, Patel J, Al Rifai M, Ayers CR, Neeland IJ, Kanaya AM, Kandula N, Blaha MJ, Nasir K, Blumenthal RS, Joshi PH. Inflammation and coronary artery calcification in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Atherosclerosis 2018; 270:49-56. [PMID: 29407888 DOI: 10.1016/j.atherosclerosis.2018.01.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/13/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory biomarkers and adipocytokines (IBA) may contribute to atherosclerosis by promoting vascular inflammation. The association between IBA and coronary artery calcium (CAC), a marker of subclinical atherosclerosis, is not well defined in South Asians (SA). We hypothesized that IBA (high sensitivity C-reactive protein [hsCRP], tumor necrosis factor alpha [TNF-α], adiponectin, and leptin) were independently associated with and improved discrimination of CAC among SA. METHODS We analyzed IBA and CAC among participants in the prospective Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. We used logistic regression models to examine cross-sectional associations of IBA with CAC presence (CAC >0) and severity (CAC >100), and C-statistics to assess the incremental contribution of each IBA to traditional risk factors (TRF) from the AHA/ACC Pooled Cohort Equations (PCE) for discrimination of CAC. RESULTS Among 906 participants in the MASALA study, women (n = 420) had significantly higher levels of hsCRP, adiponectin, and leptin but lower levels of TNF-α than men (p < .01 for all). There was no significant association between any of the four IBA and either CAC category in multivariable-adjusted models, respectively. Lastly, none of the four IBA improved discrimination of CAC presence or severity when added to elements of the PCE. CONCLUSIONS IBA were not associated with CAC presence or severity in the MASALA population. IBA did not help identify SA at risk of subclinical atherosclerosis, although associations with ASCVD events remain unclear. In SA, CAC may have a distinct pathophysiology independent of inflammation as measured by IBA.
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Affiliation(s)
- Anurag Mehta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jaideep Patel
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - Mahmoud Al Rifai
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Department of Medicine, University of Kansas School of Medicine, Wichita, KS, United States
| | - Colby R Ayers
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Namratha Kandula
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, United States; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Parag H Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States; Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States.
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8
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Maser RE, Lenhard MJ, Sneider MB, Pohlig RT. Osteoprotegerin is a Better Serum Biomarker of Coronary Artery Calcification than Osteocalcin in Type 2 Diabetes. Endocr Pract 2016; 21:14-22. [PMID: 25100392 DOI: 10.4158/ep14229.or] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is a prominent feature of atherosclerosis and is associated with cardiovascular events. In vitro studies have suggested that osteoprotegerin (OPG) and osteocalcin (OC) exert anticalcification potential in the vessel wall. The objective of this study was to investigate the association of CAC and serum bone biomarkers in persons with type 2 diabetes. METHODS We examined 50 individuals with type 2 diabetes. CAC imaging was performed by multidetector computed tomography. CAC scores ≥10, expressed in Agatston units, were considered abnormal. OC, undercarboxylated OC (ucOC), and OPG levels were determined by enzyme-linked immunosorbent assay. RESULTS Abnormal CAC scores were found for 64% of the study cohort. OPG levels were significantly elevated (5.5 ± 2.0 pmol/L vs. 4.2 ± 1.7 pmol/L; P = .026) for those with abnormal CAC scores. No univariate differences were found for OC or ucOC. Logistic regression analyses revealed that an increase in serum OPG level was significantly associated with an increase in CAC score (odds ratio, 3.324; 95% confidence interval, 1.321 to 8.359; P = .011). Longer duration of diabetes was a significant covariate (P = .026), whereas nonsignificant covariates in the final model were age, gender, systolic blood pressure, body mass index, insulin resistance determined by the homeostasis model assessment for insulin resistance, leptin, adiponectin, and glycemic control. The Nagelkerke R2 for the model was 0.66. Neither OC nor ucOC were significantly associated with elevated CAC scores. CONCLUSION Our results suggest that OPG is a more useful serum biomarker than OC or ucOC for identifying those at increased risk of arterial calcification in type 2 diabetes.
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Affiliation(s)
- Raelene E Maser
- Department of Medical Laboratory Sciences, University of Delaware, Newark, Delaware Diabetes and Metabolic Research Center, Christiana Care Health System, Newark, Delaware
| | - M James Lenhard
- Diabetes and Metabolic Research Center, Christiana Care Health System, Newark, Delaware Diabetes and Metabolic Diseases Center, Christiana Care Health System, Wilmington, Delaware
| | - Michael B Sneider
- Department of Radiology, Christiana Care Health System, Newark, Delaware
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, Delaware
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Iribarren C, Chandra M, Rana JS, Hlatky MA, Fortmann SP, Quertermous T, Go AS. High-sensitivity cardiac troponin I and incident coronary heart disease among asymptomatic older adults. Heart 2016; 102:1177-82. [PMID: 27030599 DOI: 10.1136/heartjnl-2015-309136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/25/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE High-sensitivity cardiac troponin I (hs-cTnI) is a novel biomarker of myocardial injury and ischaemia. Our objective was to ascertain correlates of hs-cTnI and its incremental prognostic utility for incident coronary heart disease (CHD) among older asymptomatic subjects. METHODS We performed a cohort study among 1135 asymptomatic control participants in the ADVANCE (Atherosclerotic Disease, VAscular FunctioN and GenetiC Epidemiology) study at Kaiser Permanente Northern California and Stanford University, with follow-up through 31 December 2014. Hs-cTnI was measured in stored baseline (2002-2004) serum samples. RESULTS After a median follow-up of 11.3 years, 164 CHD events were documented. The most significant correlates of hs-cTnI were black race, body mass index, hypertension, LDL cholesterol and estimated glomerular filtration rate (eGFR) (R(2)=0.16) After adjustment for race/ethnicity, education level, diabetes status, ATP-III Framingham risk score (FRS), C reactive protein and eGFR, each 1 SD increment of log-transformed Hs-cTnI was associated with 1.11 (95% CI 1.01 to 1.23, p=0.04) increased hazard of CHD. The c-statistic increased to 0.70 from 0.68 (p=0.16) and the category-based net reclassification index was 18% (95% CI 8% to 30%) after adding hs-cTnI to the model containing the ATP-III FRS. CONCLUSIONS Hs-cTnI conveys incremental prognostic information for incident CHD among asymptomatic older adults.
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Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA San Francisco Departments of Epidemiology, University of California, Biostatistics and Medicine, San Francisco, California, USA
| | - Malini Chandra
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Jamal S Rana
- Division of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Mark A Hlatky
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Stephen P Fortmann
- Stanford University School of Medicine, Palo Alto, California, USA Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Alan S Go
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA San Francisco Departments of Epidemiology, University of California, Biostatistics and Medicine, San Francisco, California, USA Stanford University School of Medicine, Palo Alto, California, USA
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10
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Bickel C, Schnabel RB, Zeller T, Lackner KJ, Rupprecht HJ, Blankenberg S, Sinning C, Westermann D. Predictors of leptin concentration and association with cardiovascular risk in patients with coronary artery disease: results from the AtheroGene study. Biomarkers 2016; 22:210-218. [PMID: 26769430 DOI: 10.3109/1354750x.2015.1130745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT Leptin is produced in white adipose tissue, but also in human coronary atherosclerotic lesions. OBJECTIVE The aim of this study is to assess the prognostic value of leptin in patients with proven coronary artery disease (CAD) (N = 1907). METHODS AtheroGene is a contemporary CAD cohort study (N = 3229). Median follow-up time was 3.8 (Quartile 1/3 with 2.8/4.9) years. RESULTS Leptin concentration was associated with a hazard ratio (HR) for the fully adjusted model of HR = 1.32 in women but was not significant in men. The endpoint cardiovascular death and non-fatal myocardial infarction was observed in 167 patients. CONCLUSION In women with known CAD, increased leptin concentration is useful for predicting cardiovascular death and non-fatal myocardial infarction.
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Affiliation(s)
- Christoph Bickel
- a Department of Internal Medicine , Federal Armed Forces Central Hospital , Koblenz , Germany
| | - Renate B Schnabel
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Tanja Zeller
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Karl J Lackner
- c Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg-University Mainz , Mainz , Germany
| | - Hans J Rupprecht
- d Department of Medicine II , GPR Rüsselsheim , Rüsselsheim , Germany
| | - Stefan Blankenberg
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Christoph Sinning
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Dirk Westermann
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
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11
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The response of circulating leptin levels to exercise stress testing in subjects diagnosed with metabolic syndrome. ISRN ENDOCRINOLOGY 2014; 2014:689260. [PMID: 24616817 DOI: 10.1155/2014/689260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/11/2013] [Indexed: 11/17/2022]
Abstract
Aim. To assess the plasma leptin responses after exercise stress testing in patients with metabolic syndrome (MS). Material and Methods. We investigated 67 patients with MS, with mean age of 55 ± 7 years. They underwent exercise stress testing on cycloergometer. The lot was divided into three groups: group 1-10 patients with a true positive test, group 2-18 patients with a true negative test, and group 3-39 patients with a false negative test. Leptin levels were measured using the ELISA method. Results. Leptin levels decreased after effort in patients with MS (9.42 ± 11.08 ng/mL before and 8.18 ± 11.5 ng/mL after the exercise stress test, P = 0.0005, r = 0.874). In groups 1 (8.98 ± 9.09 at rest versus 5.98 ± 8.73 ng/mL after the exercise test, P = 0.002) and 3 (8.6 ± 10.53 at rest versus 6.91 ± 9.07 ng/mL, P = 0.0005), lower leptin levels were recorded immediately after exercise testing. Leptin levels were not significantly lower in group 2 before effort (9.49 ± 11.36 ng/ml) and after (9.46 ± 13.81 ng/mL). We found no correlation between leptinemia and exercise stress testing parameters, regardless of group. Conclusion. Our research showed that short-term exercise lowers leptin levels in coronary patients, without a relationship between its parameters and leptin values.
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Peralta-Ramírez A, Montes de Oca A, Raya AI, Pineda C, López I, Guerrero F, Diez E, Muñoz-Castañeda JR, Martinez J, Almaden Y, Rodríguez M, Aguilera-Tejero E. Vitamin E protection of obesity-enhanced vascular calcification in uremic rats. Am J Physiol Renal Physiol 2014; 306:F422-9. [DOI: 10.1152/ajprenal.00355.2013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study aimed to determine the extent of extraskeletal calcification in uremic Zucker rats, by comparing obese and lean phenotypes, and to evaluate the influence of vitamin E (VitE) on the development of calcifications in both uremic rats and human vascular smooth muscle cells (HVSMCs) cultured in vitro. Zucker rats of lean and obese phenotypes with normal renal function [control (C); C-lean and C-obese groups] and with uremia [5/6 nephrectomy (Nx); Nx-lean and Nx-obese groups] and uremic rats treated with VitE (Nx-lean + VitE and Nx-obese + VitE groups) were studied. Uremic groups were subjected to Nx, fed a 0.9% phosphorus diet, and treated with calcitriol (80 ng/kg ip). The aortic calcium concentration was significantly higher ( P < 0.05) in Nx-obese rats (10.0 ± 2.1 mg/g tissue) than in Nx-lean rats (3.6 ± 1.3 mg/g tissue). A decrease in plasma glutathione peroxidase activity was observed in Nx-obese rats compared with Nx-lean rats (217.2 ± 18.2 vs. 382.3 ± 15.5 nmol·min−1·ml−1, P < 0.05). Treatment with VitE restored glutathione peroxidase activity and reduced the aortic calcium concentration to 4.6 ± 1.3 mg/g tissue. The differences in mineral deposition between Nx-lean, Nx-obese, Nx-lean + VitE, and Nx-obese + VitE rats were also evidenced in other soft tissues. In HVSMCs incubated with high phosphate, VitE also prevented oxidative stress and reduced calcium content, bone alkaline phosphatase, and gene expression of core-binding factor-α1. In conclusion, uremic obese rats develop more severe calcifications than uremic lean rats and VitE reduces oxidative stress and vascular calcifications in both rats and cultures of HVSMCs.
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Affiliation(s)
- A. Peralta-Ramírez
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
- Escuela de Medicina Veterinaria, Universidad Nacional Autónoma de Nicaragua, Leon, Nicaragua
| | - A. Montes de Oca
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
| | - A. I. Raya
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
| | - C. Pineda
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
| | - I. López
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
| | - F. Guerrero
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
| | - E. Diez
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
| | - J. R. Muñoz-Castañeda
- Unidad de Investigacion y Servicio de Nefrología (Red in Ren), Instituto Sanitario de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - J. Martinez
- Unidad de Investigacion y Servicio de Nefrología (Red in Ren), Instituto Sanitario de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - Y. Almaden
- Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and Centros de Investigación Biomédica en Red Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain; and
| | - M. Rodríguez
- Unidad de Investigacion y Servicio de Nefrología (Red in Ren), Instituto Sanitario de Investigación Biomédica de Córdoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - E. Aguilera-Tejero
- Departmento Medicina y Cirugia Animal, Universidad de Cordoba, Cordoba, Spain
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Lodh M, Goswami B, Parida A, Patra S, Saxena A. Assessment of serum leptin, pregnancy-associated plasma protein A and CRP levels as indicators of plaque vulnerability in patients with acute coronary syndrome. Cardiovasc J Afr 2013. [PMID: 22836155 DOI: 10.5830/cvja-2012-008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION A multifactorial aetiology of coronary artery disease (CAD) has been established in the recent past. Extensive research is now underway to understand the mechanisms responsible for plaque vulnerability. The identification of a novel biomarker that will help in the assessment of plaque status is urgently needed for the purpose of patient stratification and prognostication. The aim of the present study was to evaluate leptin, pregnancy-associated plasma protein A (PAPP-A) and C-reactive protein (CRP) levels in patients with acute coronary syndrome and to assess their diagnostic efficacy in the identification of vulnerable plaques. METHODS The study group comprised 105 patients who had chest pain along with ECG changes (ST elevation, ST depression, T inversion) and raised cardiac enzyme levels. Sixty-two patients with chest pain and ECG changes but with normal cardiac enzyme profiles were included in the control group. Lipid profiles, and leptin, PAPP-A and CRP levels were assessed in these two groups. Receiver operating characteristics (ROC) curves were plotted to determine the utility of the parameters under study as markers of plaque vulnerability. RESULTS Significantly higher levels of serum lipoprotein (a), leptin, PAPP-A and high-sensitivity CRP (hs-CRP) were observed in the cases than in the controls. A positive correlation was observed between CRP and PAPP-A levels as well as CRP and leptin concentrations. ROC curve analysis revealed similar efficacies of CRP and PAPP-A levels in their ability to detect unstable plaques with areas under the curve of 0.762 and 0.732, respectively. Multivariate analysis established the superiority of hs-CRP as a predictor of plaque instability. CONCLUSIONS Our study highlights the utility of both CRP and PAPP-A levels as determinants of plaque instability. Our findings necessitate population-based follow-up studies to establish the superiority of either of the two biomarkers in the field of preventive cardiology.
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Affiliation(s)
- Moushumi Lodh
- Department of Biochemistry, The Mission Hospital, Durgapur, West Bengal, India
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Guzel S, Seven A, Kocaoglu A, Ilk B, Guzel EC, Saracoglu GV, Celebi A. Osteoprotegerin, leptin and IL-6: association with silent myocardial ischemia in type 2 diabetes mellitus. Diab Vasc Dis Res 2013; 10:25-31. [PMID: 22496403 DOI: 10.1177/1479164112440815] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Diabetic patients often exhibit severe, asymptomatic coronary artery disease (CAD). The relationship between osteoprotegerin (OPG), inflammatory markers and silent myocardial ischemia remains to be elucidated. METHODS We recruited 45 type 2 diabetic patients and 33 healthy controls and assessed them for silent myocardial ischemia (SMI) by myocardial perfusion imaging. Patient blood was tested for OPG, IL-6 and leptin concentrations. RESULTS OPG, leptin and IL-6 levels were found significantly elevated in diabetic patients (p < 0.001, p < 0.01, p < 0.05). Based on our classification of presence/absence of SMI in our diabetic group, we found that there was a significant association between SMI and the biomarkers IL-6 (p < 0.001), leptin (p < 0.001) and OPG (p < 0.05). In multivariate regression analyses, OPG was found to be significantly related to diabetes mellitus and to SMI. Age, sex and smoking increased the association between OPG and SMI. CONCLUSION High OPG, leptin and IL-6 levels are associated with the presence and severity of SMI in type 2 diabetic patients.
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Affiliation(s)
- Savas Guzel
- Department of Biochemistry, Namik Kemal University, 100.YilMah. Barbaros Cad, no. 132, Tekirdag, Turkey.
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Lodh M, Goswami B, Parida A, Patra S, Saxena A. Assessment of serum leptin, pregnancy-associated plasma protein A and CRP levels as indicators of plaque vulnerability in patients with acute coronary syndrome. Cardiovasc J Afr 2012; 23:330-5. [PMID: 22836155 PMCID: PMC3734746 DOI: 10.5830/cvja-2012-008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/08/2012] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION A multifactorial aetiology of coronary artery disease (CAD) has been established in the recent past. Extensive research is now underway to understand the mechanisms responsible for plaque vulnerability. The identification of a novel biomarker that will help in the assessment of plaque status is urgently needed for the purpose of patient stratification and prognostication. The aim of the present study was to evaluate leptin, pregnancy-associated plasma protein A (PAPP-A) and C-reactive protein (CRP) levels in patients with acute coronary syndrome and to assess their diagnostic efficacy in the identification of vulnerable plaques. METHODS The study group comprised 105 patients who had chest pain along with ECG changes (ST elevation, ST depression, T inversion) and raised cardiac enzyme levels. Sixty-two patients with chest pain and ECG changes but with normal cardiac enzyme profiles were included in the control group. Lipid profiles, and leptin, PAPP-A and CRP levels were assessed in these two groups. Receiver operating characteristics (ROC) curves were plotted to determine the utility of the parameters under study as markers of plaque vulnerability. RESULTS Significantly higher levels of serum lipoprotein (a), leptin, PAPP-A and high-sensitivity CRP (hs-CRP) were observed in the cases than in the controls. A positive correlation was observed between CRP and PAPP-A levels as well as CRP and leptin concentrations. ROC curve analysis revealed similar efficacies of CRP and PAPP-A levels in their ability to detect unstable plaques with areas under the curve of 0.762 and 0.732, respectively. Multivariate analysis established the superiority of hs-CRP as a predictor of plaque instability. CONCLUSIONS Our study highlights the utility of both CRP and PAPP-A levels as determinants of plaque instability. Our findings necessitate population-based follow-up studies to establish the superiority of either of the two biomarkers in the field of preventive cardiology.
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Affiliation(s)
- Moushumi Lodh
- Department of Biochemistry, The Mission Hospital, Durgapur, West Bengal, India
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de Oliveira RB, Liabeuf S, Okazaki H, Lenglet A, Desjardins L, Lemke HD, Vanholder R, Choukroun G, Massy ZA. The clinical impact of plasma leptin levels in a cohort of chronic kidney disease patients. Clin Kidney J 2012; 6:63-70. [PMID: 27818752 PMCID: PMC5094389 DOI: 10.1093/ckj/sfs176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/30/2012] [Indexed: 01/05/2023] Open
Abstract
Background Recent research has clarified the relationship between adipokines, metabolic syndrome (MS) and cardiovascular disease (CVD). The results of animal and clinical studies have revealed a positive relationship between leptin and vascular smooth muscle cell counts and calcification, arterial rigidity, carotid thickness and the incidence of CVD. However, despite leptin fulfilling the definition of a uremic toxin, its exact role in chronic kidney disease (CKD) has yet to be determined. Methods One hundred and forty-two CKD patients (stages 2–5D) participated in this study, and were followed for a minimum of 20 months at Amiens University Medical Center. Results Leptin was negatively correlated with the glomerular filtration rate (GFR), total adiponectin (TAdip) and high-molecular weight adiponectin and positively correlated with age, waist circumference, body mass index (BMI), aortic calcification score (ACS), C-reactive protein (CRP), triglycerides, insulin and parathormone (PTH). Leptin and insulin were significantly correlated with the MS score. The BMI, insulin, MS score and PTH were independent predictors of leptin levels (P = 0.002, 0.016, 0.028 and 0.017, respectively). Leptin, insulin and TAdip were independent predictors of the presence of MS (P = 0.05, 0.04 and 0.04). However, leptin levels were not significantly predictive of the clinical outcomes. Conclusions Our study was the first to demonstrate a significant, independent link between leptin and MS (but not clinical outcomes) and PTH in patients at different CKD stages. Future studies will have to assess the involvement of leptin in MS and clinical outcomes in CKD, and the potential modulation of leptin by PTH.
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Affiliation(s)
| | - Sophie Liabeuf
- INSERM U-1088, The Jules Verne University of Picardy, Amiens, France; Clinical Research Center, Division of Clinical Pharmacology, Amiens University Medical Center, Amiens, France; The Jules Verne University of Picardy, Amiens, France
| | - Hirokazu Okazaki
- INSERM U-1088, The Jules Verne University of Picardy , Amiens , France
| | - Aurelie Lenglet
- INSERM U-1088, The Jules Verne University of Picardy, Amiens, France; Clinical Research Center, Division of Clinical Pharmacology, Amiens University Medical Center, Amiens, France; The Jules Verne University of Picardy, Amiens, France
| | - Lucie Desjardins
- Clinical Research Center, Division of Clinical Pharmacology, Amiens University Medical Center, Amiens, France; The Jules Verne University of Picardy, Amiens, France
| | | | - Raymond Vanholder
- Nephrology-Dialysis-Transplantation Department, Department of Internal Medicine , University Hospital , Ghent , Belgium
| | - Gabriel Choukroun
- Division of Nephrology , Amiens University Medical Center , Amiens , France
| | - Ziad A Massy
- INSERM U-1088, The Jules Verne University of Picardy, Amiens, France; Clinical Research Center, Division of Clinical Pharmacology, Amiens University Medical Center, Amiens, France; The Jules Verne University of Picardy, Amiens, France; Division of Nephrology, Ambroise Paré Hospital, Paris Ile de France Ouest (UVSQ) University, Paris-Boulogne Billancourt, France
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Carotid intima-media thickness and serum leptin in psoriasis. Herz 2011; 37:527-33. [PMID: 22127739 DOI: 10.1007/s00059-011-3547-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/17/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Psoriasis, a chronic inflammatory immune disorder, has been linked to increased cardiovascular mortality and morbidity. Leptin, an obesity-related peptide, has been shown to exert direct effects on the vascular endothelium and on vascular smooth muscle cells. Carotid intima-media thickness (IMT) measurement is a promising tool for detecting atherosclerosis in its pre-occlusive/subclinical phase. OBJECTIVE The objective of the study was to evaluate carotid IMT and serum leptin levels in psoriatic patients as an indicator of subclinical atherosclerosis. MATERIALS AND METHODS The study was conducted in 50 psoriatic patients and 10 healthy controls. The clinical severity of skin affection in psoriatic patients was estimated using the psoriatic area and severity index (PASI). Serum leptin levels (ng\ml) and lipid profiles [including serum triglyceride (TG), serum low density lipoproteins (LDL) and serum high density lipoproteins (HDL)] were measured from blood samples. Carotid IMT was measured using carotid duplex ultrasonography. RESULTS Psoriatic patients showed significantly higher leptin levels and higher IMT than controls. The mean of the intima-media thickness of the four vessels examined (MIMT) showed a positive correlation with patients' mean ages, disease duration, body mass index, PASI scores, systolic blood pressure, diastolic blood pressure, leptin levels, LDL levels and triglyceride levels and no correlation with the mean HDL level. CONCLUSION Psoriasis is an independent risk factor for subclinical atherosclerosis. This cardiovascular impairment is influenced mainly by disease severity, serum TG levels and serum leptin levels.
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Lago F, Gómez R, Conde J, Scotece M, Gómez-Reino JJ, Gualillo O. Cardiometabolic comorbidities and rheumatic diseases: focus on the role of fat mass and adipokines. Arthritis Care Res (Hoboken) 2011; 63:1083-90. [PMID: 21523926 DOI: 10.1002/acr.20488] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Francisca Lago
- Santiago University Clinical Hospital, Institute of Medical Research, Santiago de Compostela, Spain
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Abstract
The pathogenesis of coronary artery calcification and its role in atherogenesis has not been completely understood but is a new focus of interest in experimental and clinical research. Various bioactive substances, including hormones, have been implicated in the process of arterial calcification. This review considers the relationship between coronary artery calcification and hormones. These hormones may become therapeutic targets for the prevention of arterial calcification.
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Affiliation(s)
| | - Michael Henein
- Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Terashima M, Nguyen PK, Rubin GD, Meyer CH, Shimakawa A, Nishimura DG, Ehara S, Iribarren C, Courtney BK, Go AS, Hlatky MA, Fortmann SP, McConnell MV. Right coronary wall CMR in the older asymptomatic advance cohort: positive remodeling and associations with type 2 diabetes and coronary calcium. J Cardiovasc Magn Reson 2010; 12:75. [PMID: 21192815 PMCID: PMC3022803 DOI: 10.1186/1532-429x-12-75] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 12/30/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Coronary wall cardiovascular magnetic resonance (CMR) is a promising noninvasive approach to assess subclinical atherosclerosis, but data are limited in subjects over 60 years old, who are at increased risk. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort. RESULTS Cross-sectional images of the proximal right coronary artery (RCA) were acquired using spiral black-blood coronary CMR (0.7 mm resolution) in 223 older, community-based patients without a history of cardiovascular disease (age 60-72 years old, 38% female). Coronary measurements (total vessel area, lumen area, wall area, and wall thickness) had small intra- and inter-observer variabilities (r = 0.93~0.99, all p < 0.0001), though one-third of these older subjects had suboptimal image quality. Increased coronary wall thickness correlated with increased coronary vessel area (p < 0.0001), consistent with positive remodeling. On multivariate analysis, type 2 diabetes was the only risk factor associated with increased coronary wall area and thickness (p = 0.03 and p = 0.007, respectively). Coronary wall CMR measures were also associated with coronary calcification (p = 0.01-0.03). CONCLUSIONS Right coronary wall CMR in asymptomatic older subjects showed increased coronary atherosclerosis in subjects with type 2 diabetes as well as coronary calcification. Coronary wall CMR may contribute to the noninvasive assessment of subclinical coronary atherosclerosis in older, at-risk patient groups.
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Affiliation(s)
- Masahiro Terashima
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey D Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Ann Shimakawa
- Applied Science Laboratory-West, GE Healthcare, Menlo Park, CA, USA
| | - Dwight G Nishimura
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University School of Medicine, Stanford, CA, USA
| | - Shoichi Ehara
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Brian K Courtney
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
- Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mark A Hlatky
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen P Fortmann
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University School of Medicine, Stanford, CA, USA
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part II: role of cigarette smoking in cardiovascular disease development. Biomark Med 2010; 3:617-53. [PMID: 20477529 DOI: 10.2217/bmm.09.51] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Potential mechanisms and biomarkers of atherosclerosis related to cigarette smoking - a modifiable risk factor for that disease - are discussed in this article. These include smoking-associated inflammatory markers, such as leukocytes, high-sensitivity C-reactive protein, serum amyloid A, ICAM-1 and IL-6. Other reviewed markers are indicative for smoking-related impairment of arterial endothelial function (transcapillary leakage of albumin, inhibition of endogenous nitric oxide synthase activity and reduced endothelium-dependent vasodilation) or point to oxidative stress caused by various chemicals (cholesterol oxidation, autoantibodies to oxidized low-density lipoprotein, plasma levels of malondialdehyde and F(2)-isoprostanes and reduced antioxidant capacity). Smoking enhances platelet aggregability, increases blood viscosity and shifts the pro- and antithrombotic balance towards increased coagulability (e.g., fibrinogen, von Willebrand factor, ICAM-1 and P-selectin). Insulin resistance is higher in smokers compared with nonsmokers, and hemoglobin A1c is dose-dependently elevated, as is homocysteine. Smoke exposure may influence the kinetics of markers with different response to transient or chronic changes in cigarette smoking behavior.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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Kocić I, Racek-Król B, Wapniarska I, Rusiecka I, Wasilewski R, Bitel M. Antiplatelet effect of statins is augmented in diabetic rabbits. Pharmacol Rep 2010; 62:410-3. [DOI: 10.1016/s1734-1140(10)70282-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/20/2009] [Indexed: 11/29/2022]
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Kastarinen H, Kesäniemi YA, Ukkola O. Leptin and lipid metabolism in chronic kidney failure. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:401-8. [PMID: 19148833 DOI: 10.1080/00365510802706645] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In the general population, leptin has been associated with atherosclerosis and has been shown to interfere with lipoprotein profiles. Patients with chronic renal failure are at increased risk of cardiovascular disease and display alterations in both lipoprotein and leptin levels. The aim of this study was to investigate the relationship between leptin and the lipoprotein profile in non-dialyzed patients with chronic kidney disease (CKD). MATERIAL AND METHODS Leptin and lipid and lipoprotein concentrations were studied in 73 CKD patients and in 68 healthy controls in a cross-sectional case-control design. RESULTS The mean leptin levels were increased in the CKD patients (24.0 (SD 37.1) ng/mL) compared to those in controls (9.0 (SD 8.5) ng/mL) (p = 0.008). Also, the ratio between leptin levels and body mass index (leptin/BMI) was increased in CKD patients (mean 0.80 (SD 1.03)) compared to that in controls (0.31 (SD 0.24)) (p = 0.001). In linear regression analysis, leptin independently predicted total cholesterol and triglycerides in CKD patients (p = 0.010 and p = 0.001, respectively) and ratio between total and HDL cholesterol (Chol/HDL) in controls (p = 0.024). Furthermore, in CKD patients, the leptin/BMI predicted the variation in total cholesterol and triglycerides (p = 0.010 and p = 0.002, respectively). CONCLUSIONS Leptin concentrations and leptin/BMI were elevated in CKD patients compared to those in controls. Leptin levels in both study groups, and leptin/BMI in the CKD group, were associated with atherogenic lipid profiles, which may contribute to the elevated cardiovascular risk that has been linked to hyperleptinaemia.
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Affiliation(s)
- H Kastarinen
- Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu, Oulu, Finland
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Iribarren C, Hlatky MA, Chandra M, Fair JM, Rubin GD, Go AS, Burt JR, Fortmann SP. Incidental pulmonary nodules on cardiac computed tomography: prognosis and use. Am J Med 2008; 121:989-96. [PMID: 18954846 DOI: 10.1016/j.amjmed.2008.05.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/13/2008] [Accepted: 05/14/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND Small asymptomatic lung nodules are found frequently in the course of cardiac computed tomography (CT) scanning. However, the utility of assessing and reporting incidental findings in healthy, asymptomatic subjects is unknown. METHODS The sample comprised 1023 60- to 69-year-old subjects free of clinical cardiovascular disease and cancer who participated in the Atherosclerotic Disease, VAscular functioN and genetiC Epidemiology Study. All subjects underwent cardiac CT for determination of coronary calcium between 2001 and 2004, and the first 459 subjects were assessed for incidental pulmonary findings. We used health plan clinical databases to ascertain 24-month health care use and clinical outcomes. RESULTS Noncalcified pulmonary nodules were reported in 81 of 459 subjects (18%). Chest CT was performed on 78% of participants in the 24 months after notification, compared with 2.5% in the previous 24 months. Chest x-ray use increased from 28% to 49%. The mean number of chest CT scans per subject was 1.3 (range, 0-5). Although no malignant lesions were diagnosed in the group who had pulmonary findings read, 1 lung cancer case was diagnosed in the group who did not have lung findings read. Among the 63 participants followed up by CT, the original lesion was not identified in 22 participants (35%), the lesion had decreased or remained stable in 39 participants (62%), and there was interval growth in 2 participants (3%). CONCLUSION Reporting noncalcified pulmonary nodules resulted in substantial rescanning that overwhelmingly revealed resolution or stability of pulmonary nodules, arguing for benign processes.
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Affiliation(s)
- Carlos Iribarren
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA.
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Hajer GR, van Haeften TW, Visseren FLJ. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J 2008; 29:2959-71. [PMID: 18775919 DOI: 10.1093/eurheartj/ehn387] [Citation(s) in RCA: 952] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The classical perception of adipose tissue as a storage place of fatty acids has been replaced over the last years by the notion that adipose tissue has a central role in lipid and glucose metabolism and produces a large number of hormones and cytokines, e.g. tumour necrosis factor-alpha, interleukin-6, adiponectin, leptin, and plasminogen activator inhibitor-1. The increased prevalence of excessive visceral obesity and obesity-related cardiovascular risk factors is closely associated with the rising incidence of cardiovascular diseases and type 2 diabetes mellitus. This clustering of vascular risk factors in (visceral) obesity is often referred to as metabolic syndrome. The close relationship between an increased quantity of visceral fat, metabolic disturbances, including low-grade inflammation, and cardiovascular diseases and the unique anatomical relation to the hepatic portal circulation has led to an intense endeavour to unravel the specific endocrine functions of this visceral fat depot. The objective of this paper is to describe adipose tissue dysfunction, delineate the relation between adipose tissue dysfunction and obesity and to describe how adipose tissue dysfunction is involved in the development of diabetes mellitus type 2 and atherosclerotic vascular diseases. First, normal physiology of adipocytes and adipose tissue will be described.
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Affiliation(s)
- Gideon R Hajer
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Qasim A, Mehta NN, Tadesse MG, Wolfe ML, Rhodes T, Girman C, Reilly MP. Adipokines, insulin resistance, and coronary artery calcification. J Am Coll Cardiol 2008; 52:231-6. [PMID: 18617073 DOI: 10.1016/j.jacc.2008.04.016] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 04/25/2008] [Accepted: 04/28/2008] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We evaluated the hypothesis that plasma levels of adiponectin and leptin are independently but oppositely associated with coronary artery calcification (CAC), a measure of subclinical atherosclerosis. In addition, we assessed which biomarkers of adiposity and insulin resistance are the strongest predictors of CAC beyond traditional risk factors, metabolic syndrome, and plasma C-reactive protein (CRP). BACKGROUND Adipokines are fat-secreted biomolecules with pleiotropic actions that converge in diabetes and cardiovascular disease. METHODS We examined the association of plasma adipocytokines with CAC in 860 asymptomatic, nondiabetic participants in the SIRCA (Study of Inherited Risk of Coronary Atherosclerosis). RESULTS Plasma adiponectin and leptin levels had opposite and distinct associations with adiposity, insulin resistance, and inflammation. Plasma leptin was positively (top vs. bottom quartile) associated with higher CAC after adjustment for age, gender, traditional risk factors, and Framingham risk scores (tobit regression ratio 2.42 (95% confidence interval [CI]: 1.48 to 3.95; p = 0.002) and further adjustment for metabolic syndrome and CRP (tobit regression ratio: 2.31; 95% CI: 1.36 to 3.94; p = 0.002). In contrast, adiponectin levels were not associated with CAC. Comparative analyses suggested that levels of leptin, interleukin-6, and soluble tumor necrosis factor receptor-2, as well as the homeostasis model assessment of insulin resistance (HOMA-IR) index, predicted CAC scores, but only leptin and HOMA-IR provided value beyond risk factors, metabolic syndrome, and CRP. CONCLUSIONS In SIRCA, although both leptin and adiponectin levels were associated with metabolic and inflammatory markers, only leptin was a significant independent predictor of CAC. Of several metabolic markers, leptin and the HOMA-IR index had the most robust, independent associations with CAC.
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Affiliation(s)
- Atif Qasim
- Cardiovascular Institute and Institute for Translational Medicine and Therapeutics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Raggi P, Kleerekoper M. Contribution of Bone and Mineral Abnormalities to Cardiovascular Disease in Patients with Chronic Kidney Disease: Figure 1. Clin J Am Soc Nephrol 2008; 3:836-43. [DOI: 10.2215/cjn.02910707] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gualillo O, González-Juanatey JR, Lago F. The emerging role of adipokines as mediators of cardiovascular function: physiologic and clinical perspectives. Trends Cardiovasc Med 2008; 17:275-83. [PMID: 18021938 DOI: 10.1016/j.tcm.2007.09.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/14/2007] [Accepted: 09/17/2007] [Indexed: 01/08/2023]
Abstract
Interest in the biology of white adipose tissue has increased dramatically since the discovery of leptin in 1994. The identification of the product of the gene obese (ob) threw light on the role of adipose tissue in the physiopathology of obesity-related diseases and spurred the identification of numerous other adipokines, many of a proinflammatory nature. It has become increasingly evident that white adipose tissue-derived cytokines mediate between obesity-related exogenous factors (nutrition and lifestyle) and the molecular events that lead to metabolic syndrome, inflammation, and cardiovascular diseases. Here we review recent adipokine research, with particular attention to the roles of adiponectin, leptin, resistin, visfatin, apelin, omentin, and chemerin in such conditions.
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Affiliation(s)
- Oreste Gualillo
- Research Laboratory 4 (Laboratory of Neuro Endocrine Interactions in Rheumatology and Inflammatory Diseases), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
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Viikari LA, Huupponen RK, Viikari JSA, Marniemi J, Eklund C, Hurme M, Lehtimäki T, Kivimäki M, Raitakari OT. Relationship between leptin and C-reactive protein in young Finnish adults. J Clin Endocrinol Metab 2007; 92:4753-8. [PMID: 17878255 DOI: 10.1210/jc.2007-0103] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Leptin and C-reactive protein (CRP) concentrations are increased in inflammation, and both have been linked to increased risk for cardiovascular diseases. OBJECTIVE The objective of the study was to explore in a population-based sample whether the relation between leptin and CRP is independent of obesity level and whether genetic causes of CRP elevation contribute to leptin levels. DESIGN This was a population-based study including 1862 young adults (971 women; 891 men) aged 24-39 yr. SETTING The study was conducted at five centers in Finland. MAIN OUTCOME MEASURES Associations between leptin and CRP adjusted for obesity indices, risk factors, genetic variables, and lifestyle variables were measured. RESULTS Women had 3.0-fold higher median concentrations of leptin (12.5 vs. 4.1 ng/ml) and 1.3-fold higher median concentrations of CRP (0.75 vs. 0.56 mg/liter) than men (P < 0.0001 in both comparisons). In univariate analyses, CRP and leptin were significantly intercorrelated (r = 0.47, P < 0.0001 for women; r = 0.46, P < 0.0001 for men). In multiple regression analysis including age, body mass index, waist circumference, insulin, lipids, systolic and diastolic blood pressures, smoking status, and use of oral contraceptives in women, leptin was the main determinant of CRP in men (P < 0.0001) and the second most important determinant in women (P < 0.0001). A Mendelian randomization test based on genetic variants in the CRP gene (five single nucleotide polymorphisms) provided no support for CRP as a causal agent for leptin. CONCLUSIONS Leptin, obesity, and oral contraceptive use in women were the main factors related to CRP. The relation between leptin and CRP was independent of obesity and cardiovascular risk factors.
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Affiliation(s)
- Liisa A Viikari
- Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20521 Turku, Finland
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Golledge J, Jayalath R, Oliver L, Parr A, Schurgers L, Clancy P. Relationship between CT anthropometric measurements, adipokines and abdominal aortic calcification. Atherosclerosis 2007; 197:428-34. [PMID: 17675038 PMCID: PMC2288671 DOI: 10.1016/j.atherosclerosis.2007.06.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 06/18/2007] [Accepted: 06/22/2007] [Indexed: 01/01/2023]
Abstract
BACKGROUND Visceral obesity and aortic calcification are both associated with cardiovascular events. The purpose of this study was to examine if visceral obesity was associated with the severity of abdominal aortic calcification. METHODS One hundred and forty eight patients with peripheral artery disease were assessed by CT angiography. The severity of infrarenal abdominal aortic calcification was measured using a validated technique. The size of the visceral and subcutaneous compartments was estimated from anthropometric measurements made from the same CT. Calcification and anthropometric measurements were compared with Spearman's correlation and multiple logistic regression (adjusting for age, gender, hypertension, diabetes, smoking and cholesterol). RESULTS The relative size of the visceral compartment estimated from CT diameter ratios was correlated with abdominal aortic calcification severity, r=0.27, p=0.001 and independently associated with calcification allowing for other cardiovascular risk factors (OR 6.63, 95% CI 1.90-23.14). The relative size of the visceral compartment was associated with serum osteoprotegerin levels, suggesting a possible mechanism underlying the detrimental influence of visceral adiposity. CONCLUSION The association of visceral adiposity and arterial calcification suggests one mechanism, which may contribute to the detrimental effects of central obesity.
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Affiliation(s)
- Jonathan Golledge
- Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Qld 4811, Australia.
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