Adipocytokines, C-reactive protein, and cardiovascular disease: a population-based prospective study

Deep learning-based prediction of coronary artery calcium scoring in hemodialysis patients using radial artery calcification

OBJECTIVE

This study used random forest model to explore the feasibility of radial artery calcification in prediction of coronary artery calcification in hemodialysis patients.

MATERIAL AND METHODS

We enrolled hemodialysis patients and performed ultrasound examinations on their radial arteries to evaluate the calcification status using a calcification index. All involved patients received coronary artery computed tomography scans to generate coronary artery calcification scores (CACS). Clinical variables were collected from all patients. We constructed both a random forest model and a logistic regression model to predict CACS. Logistic regression model was used to identify the risk factors of radial artery calcification.

RESULTS

One hundred eighteen patients were included in our analysis. In random forest model, the radial artery calcification index, age, serum C-reactive protein, body mass index (BMI), diabetes, and hypertension history were related to CACS based on the average decrease of the Gini coefficient. The random forest model achieved a sensitivity of 76.9%, specificity of 75.0%, and area under receiver operating characteristic of 0.869, while the logistic regression model achieved a sensitivity of 75.2%, specificity of 68.7%, and area under receiver operating characteristic of 0.742 in prediction of CACS. Sex, BMI index, smoking history, hypertension history, diabetes history, and serum total calcium were all the risk factors related to radial artery calcification.

CONCLUSIONS

A random forest model based on radial artery calcification could be used to predict CACS in hemodialysis patients, providing a potential method for rapid screening and prediction of coronary artery calcification.

The role of leptin in ischemic stroke and its subtypes: A Mendelian randomization study

BACKGROUND AND AIMS

Observational studies have suggested a relationship between leptin and risk of stroke. However, evidence for the association remains inconsistent, and whether the association reflects a causal relationship remains to be established. To clarify this relationship, we adopted a two-sample Mendelian randomization (MR) analysis to investigate whether leptin plays a causal role in the risk of stroke and its subtypes.

METHODS AND RESULTS

Five independent single-nucleotide polymorphisms (SNPs) associated with the leptin level from genome-wide association studies (GWASs) of European individuals were selected. We performed an MR analysis using the inverse-variance-weighted (IVW) as primary method to examine the causal effects of leptin on ischemic stroke (IS). Moreover, MR-Egger intercept and Cochran's Q statistic were also performed to detect the pleiotropy or heterogeneity of our MR results. Genetically predicted circulating leptin level was not associated with ischemic stroke [odds ratio (OR): 1.48, 95% confidence interval (CI): 0.78-2.8, P = 0.22], large artery stroke (OR: 1.44, 95% CI: 0.39-5.25, P = 0.57), cardioembolic stroke (OR:1.33, 95% CI: 0.55-3.22, P = 0.52), and small vessel stroke (OR: 1.48, 95% CI: 0.39-5.63, P = 0.56) using the IVW method. Likewise, there is no convincing evidence for the associations between leptin levels and cardiovascular diseases (CVD) risk factors.

CONCLUSIONS

This study did not provide evidence that leptin levels are associated with increased risk of stroke and its subtypes.

Polygenic risk score in comparison with C-reactive protein for predicting incident coronary heart disease

BACKGROUND AND AIMS

Despite interest in the use of polygenic risk scores (PRS) for predicting coronary heart disease (CHD) risk, the clinical utility of PRS compared to conventional risk factors has not been demonstrated. We compared the performance of PRS with that of high-sensitivity C-reactive protein (hsCRP) in two well-established cohorts.

METHODS

The study population included individuals of European ancestry free of baseline CHD from ARIC (N = 13,113) and the Framingham Offspring Study (FHS) (N = 2,696). The primary predictors included a validated PRS consisting of >6.6 million single nucleotide polymorphisms and hsCRP. The outcome was incident CHD, defined as non-fatal or fatal myocardial infarction. We compared the performance of both predictors after adjusting for the Pooled Cohort Equations in multivariable-adjusted Cox regression models. We assessed discrimination and reclassification using c-statistics and net reclassification improvement.

RESULTS

Incident CHD occurred in 565 ARIC and 153 FHS participants. In multivariable-adjusted models, both PRS and hsCRP were associated with incident CHD (p < 0.05 in both cohorts). In models incorporating both predictors, strengths of association were similar. For instance, in ARIC, the hazard ratio per SD increment was 1.38 (95% CI, 1.27-1.50, p = 2.94 × 10-14) for PRS and 1.41 (1.30-1.55, p = 3.10 × 10-15) for hsCRP. Neither predictor significantly increased model discrimination or net reclassification when compared with models containing the Pooled Cohort Equations alone.

CONCLUSIONS

In two independent cohorts, PRS performed similarly to hsCRP for the prediction of CHD risk. These findings suggest PRS does not have unique clinical utility beyond this widely-available, inexpensive measure of risk in unselected middle-aged populations.

Inflammation biomarkers are associated with the incidence of cardiovascular disease: a meta-analysis

Background

Inflammation is a risk factor for cardiovascular disease (CVD), and particular inflammatory parameters can be used to predict the incidence of CVD. The aim of this study was to assess the association between fibrinogen (FIB), interleukin-6 (IL-6), C-reactive protein (CRP) and galectin-3 (Gal-3) and the risk of cardiovascular disease using meta-analysis.

Methods

PubMed, Embase, Scopus, and Web of Science databases were searched with the appropriate strategies to identify observational studies relevant to this meta-analysis. A random-effects model was used to combine inflammation factor-associated outcomes and cardiovascular disease outcomes, except in the case of galectin-3, where a fixed-effects model was used because of less heterogeneity. Location, age, type of cardiovascular disease, and sample size factors were used to explore heterogeneity in stratification and metaregression for subgroup analysis. A case-by-case literature exclusion approach was used for sensitivity analysis. The funnel plot and Begg's test were combined to assess publication bias.

Results

Thirty-three papers out of 11,456 were screened for inclusion in the analysis. Four inflammation biomarkers were significantly associated with the development of CVD: FIB (OR: 1.21, 95% CI: 1.15-1.27, P < 0.001; HR: 1.04, 95% CI: 1.00-1.07, P < 0.05), IL-6 (HR: 1.16, 95% CI: 1.10-1.22, P < 0.001), CRP (OR: 1.25, 95% CI: 1.15-1.35, P < 0.001; HR: 1.20, 95% CI: 1.14-1.25, P < 0.001) and Gal-3 (HR: 1.09, 95% CI: 1.05-1.14, P < 0.001). Location factors help explain the source of heterogeneity, and there is publication bias in the Gal-3 related literature.

Conclusion

Taken together, the current research evidence suggests that high levels of fibrinogen, interleukin-6, C-reactive protein and galectin-3 are risk factors for cardiovascular disease and can be used as biomarkers to predict the development of cardiovascular disease to some extent.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023391844.

Exploring the underlying mechanisms linking adiposity and cardiovascular disease: A prospective cohort study of 404,332 UK Biobank participants

BACKGROUND AND AIMS

Obesity is causally associated with multiple cardiovascular outcomes but effective population measure to control obesity is limited. This study aims to decipher to which extent excess atherosclerotic cardiovascular diseases (ASCVD) and heart failure (HF) risk due to obesity can be explained by conventional risk factors.

METHODS

This is a prospective cohort study of 404,332 White UK Biobank participants. Participants with prior CVDs or other chronic diseases at baseline, or body mass index (BMI) <18·5 kg/m2 were excluded. Data were collected at the baseline assessment between 2006 and 2010. Linkage to death registrations and hospital admission records was used to ascertain ASCVD and HF outcomes up to late 2021. Obesity was defined as BMI ≥30 kg/m2. Candidate mediators included lipids, blood pressure, glycated haemoglobin (HbA1c), and liver and kidney function markers, which were chosen based on clinical trials and Mendelian randomisation studies. Cox proportional hazard models were used to estimate hazard ratios (HR) and their 95% confidence intervals (CIs). Mediation analysis based on g-formula was used to separately estimate the relative importance of mediators for ASCVD and HF.

RESULTS

Compared with people without obesity, obese people had an increased risk of ASCVD (HR 1.30, 95% CI 1.26-1.35) and HF (HR 2.04, 95% CI 1.96-2.13) after adjusting for sociodemographic and lifestyle factors and medications for cholesterol, blood pressure and insulin. The strongest mediators for ASCVD were renal function (eGFR: mediation proportion: 44.6%), blood pressure (SBP: 24.4%; DBP: 31.1%), triglycerides (19.6%), and hyperglycaemia (HbA1c 18.9%). These mediators collectively explained more excess risk of ASCVD than that of HF.

CONCLUSIONS

Interventions that help obese individuals to maintain healthy lipid concentrations, blood pressure, glycaemic control and kidney function could potentially alleviate a sizable proportion of the ASCVD burden. However, HF burden could not be meaningfully reduced without weight management.

The Role of Adipokines in Inflammatory Mechanisms of Obesity

Adipokines are currently widely studied cellular signaling proteins produced by adipose tissue and involved in various processes, including inflammation; energy and appetite modulation; lipid and glucose metabolism; insulin sensitivity; endothelial cell functioning; angiogenesis; the regulation of blood pressure; and hemostasis. The current review attempted to highlight the key functions of adipokines in the inflammatory mechanisms of obesity, its complications, and its associated diseases. An extensive search for materials on the role of adipokines in the pathogenesis of obesity was conducted online using the PubMed and Scopus databases until October 2022.

Inflammatory Markers in Cardiovascular Disease; Lessons Learned and Future Perspectives

BACKGROUND

Cardiovascular disease (CVD) still remains the leading cause of morbidity and mortality worldwide. It is now established that inflammation plays a crucial role in atherosclerosis and atherothrombosis, and thus, it is closely linked to cardiovascular disease.

OBJECTIVE

The aim of the present review is to summarize and critically appraise the most relevant evidence regarding the potential use of inflammatory markers in the field of CVD.

METHODS

We conducted a comprehensive research of the relevant literature, searching MEDLINE from its inception until November 2018, primarily for meta-analyses, randomized controlled trials and observational studies.

RESULTS

Established markers of inflammation, mainly C-reactive protein, have yielded significant results both for primary and secondary prevention of CVD. Newer markers, such as lipoprotein-associated phospholipase A2, lectin-like oxidized low-density lipoprotein receptor-1, cytokines, myeloperoxidase, cell adhesion molecules, matrix metalloproteinases, and the CD40/CD40 ligand system, have been largely evaluated in human studies, enrolling both individuals from the general population and patients with established CVD. Some markers have yielded conflicting results; however, others are now recognized not only as promising biomarkers of CVD, but also as potential therapeutic targets, establishing the role of anti-inflammatory and pleiotropic drugs in CVD.

CONCLUSION

There is significant evidence regarding the role of consolidated and novel inflammatory markers in the field of diagnosis and prognosis of CVD. However, multimarker model assessment, validation of cut-off values and cost-effectiveness analyses are required in order for those markers to be integrated into daily clinical practice.

Sleep disturbances and physical health problems in caregivers of children with ASD

OBJECTIVES

Caregivers of children with autism spectrum disorder self-report more physical health problems than controls. Sleep disturbances are also more prevalent in caregivers, and are positively associated with physical health problems. The negative impact of caring for a child with ASD on physical health therefore, might occur indirectly via poorer sleep.

METHODS

Participants, of which n = 43 were caregivers and n = 17 were controls, completed self-report measures of physical health problems and, to capture objective measures of sleep, wore an actigraphy device.

RESULTS

Physical health problems were greater in caregivers, as were subjective reports of disturbed sleep. Objectively, waking after sleep onset (WASO) and average number of awakenings were higher, as was sleep latency, and sleep efficiency was poorer, in caregivers. Total sleep time however, was greater in caregivers, as was time in bed. Physical health problems, while unrelated to actigraphy measures, were positively associated with self-reported sleep disturbances. Caregivers' increased risk for physical health problems occurred indirectly via greater self-reports of disturbed sleep.

CONCLUSIONS

Interventions that help alleviate caregivers' sleep disturbances might be effective, by reducing physical health problems, for improving quality of provided care, and this might be explored in future research.

Leptin in Leanness and Obesity: JACC State-of-the-Art Review

Leptin has emerged over the past 2 decades as a key hormone secreted by adipose tissue that conveys information on energy stores. Leptin is considered an important regulator of both neuroendocrine function and energy homeostasis. Numerous studies (mainly preclinical and much less in humans) have investigated the mechanisms of leptin's actions both in the healthy state as well as in a wide range of metabolic diseases. In this review, the authors present leptin physiology and review the main findings from animal studies, observational and interventional studies, and clinical trials in humans that have investigated the role of leptin in metabolism and cardiometabolic diseases (energy deficiency, obesity, diabetes, cardiovascular diseases, nonalcoholic fatty liver disease). The authors discuss the similarities and discrepancies between animal and human biology and present clinical applications of leptin, directions for future research, and current approaches for the development of the next-generation leptin analogs.

Adipose tissue dysregulation at the onset of psychosis: Adipokines and social determinants of health

Recent evidence suggests that patients with psychotic disorders have metabolic disturbances (e.g., insulin resistance, dyslipidemia) at the onset of the disease and before antipsychotic exposure. Such disturbances are strongly associated with adipose tissue dysregulation. Measuring adipokines, the molecular mediators of adipose function, could provide a picture of the state of metabolic regulation at the onset of psychosis. The present study explores adipokine changes in a population of first-episode psychosis (FEP) patients with minimal prior exposure to antipsychotics. The effects of social determinants of health (childhood trauma and minority status) associated with both metabolic and psychotic disorders were studied as potential determinants of this phenomenon. Data was collected through the Signature project, a biobank of clinical, socio-demographic, and biological markers. Adipokines (leptin, adiponectin, resistin and chemerin) were measured in serum of FEP patients with minimal exposure to antipsychotics (N = 48) and controls (N = 39). Data were analyzed with univariate (t-tests) and multivariate (linear regression) statistical methods. Patients, compared to controls, had significantly higher levels of adiponectin and resistin, and significantly lower levels of leptin and chemerin. These results persisted after controlling for sex, waist-to-height ratio, childhood trauma, and visible minority status. Adiponectin and chemerin retained their effects after further controlling for tobacco and depression. Resistin increased with childhood trauma scores; chemerin was higher in visible minority patients. Adipose tissue dysfunction is present in FEP patients, before exposure to antipsychotics. Social determinants of health contribute to adipose (and metabolic) dysregulation in FEP, but may not be the main determinants of this relationship.

Black rice with giant embryo ameliorates serum C-reactive protein in adults with metabolic syndrome

Metabolic syndrome is well known to increase the risk of cardiovascular diseases. We have reported that phytochemicals rich black rice with giant embryo reduced fat mass and metabolic disorders in an animal model. However, such effects have not been evaluated in humans. Subjects with metabolic syndrome (n = 49, 38 male, 44.3 ± 6.1 years) were randomly assigned into two groups and ingested roasted black-rice with giant embryo (BR, n = 26, 20 male) or white-rice (WR, n = 23, 18 male) powders mixed with water for breakfast for three months. Subjects were evaluated for various metabolic parameters before and after intervention. All parameters were not significantly different between groups before starting the intervention. After three months of consumption of either BR or WR, changes of body weight in BR vs WR groups (–1.54 kg vs –1.29 kg, p = 0.649) as well as waist circumference (–1.63 cm vs –1.02 cm, p = 0.365) were not significantly different between groups. However, changes in highly-sensitive C reactive proteins in BR vs WR groups (–0.110 mg/dl vs 0.017 mg/dl, p = 0.003) had significant differences. Three months of meal replacement with BR had a significant reduction of highly-sensitive C reactive protein compared to those with WR in adults with metabolic syndrome.

An Overview of the Role of Adipokines in Cardiometabolic Diseases

Obesity as an independent risk factor for cardiovascular diseases (CVDs) leads to an increase in morbidity, mortality, and a shortening of life span. The changes in heart structure and function as well as metabolic profile are caused by obese people, including those free of metabolic disorders. Obesity alters heart function structure and affects lipid and glucose metabolism, blood pressure, and increase inflammatory cytokines. Adipokines, specific cytokines of adipocytes, are involved in the progression of obesity and the associated co-morbidities. In the current study, we review the scientific evidence on the effects of obesity on CVDs, focusing on the changes in adipokines. Several adipokines have anti-inflammatory and cardioprotective effects comprising omentin, apelin, adiponectin, and secreted frizzled-related protein (Sfrp-5). Other adipokines have pro-inflammatory impacts on the cardiovascular system and obesity including leptin, tumor necrosis factor (TNF), retinol-binding protein4 (RBP-4), visfatin, resistin, and osteopontin. We found that obesity is associated with multiple CVDs, but can only occur in unhealthy metabolic patients. However, more studies should be designed to clarify the association between obesity, adipokine changes, and the occurrence of CVDs.

Novel Invasive and Noninvasive Cardiac-Specific Biomarkers in Obesity and Cardiovascular Diseases

Cardiovascular disease (CVD) is the leading cause of fatality and disability worldwide regardless of gender. Obesity has reached epidemic proportions in population across different regions. According to epidemiological studies, CVD risk markers in childhood obesity are one of the significant risk factors for adulthood CVD, but have received disproportionally little attention. This review has examined the evidence for the presence of traditional cardiac biomarkers (nonspecific; lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, myoglobulin, glycogen phosphorylase isoenzyme BB, myosin light chains, ST2, and ischemia-modified albumin) and novel emerging cardiac-specific biomarkers (cardiac troponins, natriuretic peptides, heart-type fatty acid-binding protein, and miRNAs). Besides, noninvasive anatomical and electrophysiological markers (carotid intima-media thickness, coronary artery calcification, and heart rate variability) in CVDs and obesity are also discussed. Modifiable and nonmodifiable risk factors associated with metabolic syndrome in the progression of CVD, such as obesity, diabetes, hypertension, dyslipidemia, oxidative stress, inflammation, and adipocytokines are also outlined. These underlying prognostic risk factors predict the onset of future microvascular and macrovascular complications. The understanding of invasive and noninvasive cardiac-specific biomarkers and the risk factors may yield valuable insights into the pathophysiology and prevention of CVD in a high-risk obese population at an early stage.

Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Incorporating nontraditional risk factors may improve the performance of traditional multivariable risk assessment for cardiovascular disease (CVD).

OBJECTIVE

To systematically review evidence for the US Preventive Services Task Force on the benefits and harms of 3 nontraditional risk factors in cardiovascular risk assessment: the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score.

DATA SOURCES

MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for studies published through May 22, 2017. Surveillance continued through February 7, 2018.

STUDY SELECTION

Studies of asymptomatic adults with no known cardiovascular disease.

DATA EXTRACTION AND SYNTHESIS

Independent critical appraisal and data abstraction by 2 reviewers.

MAIN OUTCOMES AND MEASURES

Cardiovascular events, mortality, risk assessment performance measures (calibration, discrimination, or risk reclassification), and serious adverse events.

RESULTS

Forty-three studies (N = 267 244) were included. No adequately powered trials have evaluated the clinical effect of risk assessment with nontraditional risk factors on patient health outcomes. The addition of the ABI (10 studies), hsCRP level (25 studies), or CAC score (19 studies) can improve both discrimination and reclassification; the magnitude and consistency of improvement varies by nontraditional risk factor. For the ABI, improvements in performance were the greatest for women, in whom traditional risk assessment has poor discrimination (C statistic change of 0.112 and net reclassification index [NRI] of 0.096). Results were inconsistent for hsCRP level, with the largest analysis (n = 166 596) showing a minimal effect on risk prediction (C statistic change of 0.0039, NRI of 0.0152). The largest improvements in discrimination (C statistic change ranging from 0.018 to 0.144) and reclassification (NRI ranging from 0.084 to 0.35) were seen for CAC score, although CAC score may inappropriately reclassify individuals not having cardiovascular events into higher-risk categories, as determined by negative nonevent NRI. Evidence for the harms of nontraditional risk factor assessment was limited to computed tomography imaging for CAC scoring (8 studies) and showed that radiation exposure is low but may result in additional testing.

CONCLUSIONS AND RELEVANCE

There are insufficient adequately powered clinical trials evaluating the incremental effect of the ABI, hsCRP level, or CAC score in risk assessment and initiation of preventive therapy. Furthermore, the clinical meaning of improvements in measures of calibration, discrimination, and reclassification risk prediction studies is uncertain.

Visceral Adipose Tissue Accumulation and Residual Cardiovascular Risk

PURPOSE OF THE REVIEW

Low-grade systemic inflammation increases residual cardiovascular risk. The pathogenesis of low-grade systemic inflammation is not well understood.

RECENT FINDINGS

Visceral adipose tissue accumulates when the subcutaneous adipose tissue can no longer store excess nutrients. Visceral adipose tissue inflammation initially facilitates storage of nutrients but with time become maladaptive and responsible for low-grade systemic inflammation. Control of low-grade systemic inflammation requires reversal of visceral adipose tissue accumulation with intense and sustained aerobic exercise or bariatric surgery. Alternatively, pharmacologic inhibition of the inflammatory signaling pathway may be considered. Reversal visceral adipose tissue accumulation lowers residual cardiovascular risk.

Longitudinal Increases in Adiposity Contribute to Worsening Adipokine Profile over Time in Mexican Americans

OBJECTIVE

Limited studies have assessed the relationship between longitudinal changes in adiposity and changes in multiple adipokines over time. This study examined changes in BMI, total body fat, and trunk fat associated with changes in 16 circulating adipokines in Mexican Americans at risk for type 2 diabetes.

METHODS

Participants included 1,213 individuals with cross-sectional data and a subset of 368 individuals with follow-up measures (mean 4.6 ± 1.5 years from baseline). Joint multivariate associations between 3 adiposity measures and 16 adipokines were assessed by canonical correlation analysis.

RESULTS

Longitudinal increases in adiposity were most strongly associated with increasing leptin, C-reactive protein (CRP), and interleukin 1 receptor antagonist (IL-1Ra) and decreasing adiponectin and secreted frizzled protein 5 (SFRP5) over time. Participants with BMI ≥ 30 kg/m² at baseline had greater increases in leptin, CRP, IL-1Ra, and interleukin 6 (IL-6) and greater decreases in adiponectin and SFRP5, associated with increasing adiposity over follow-up, than those with BMI < 30 kg/m² . Associations between adiposity and adipokines were most accounted for by leptin; adjustment for leptin greatly reduced the magnitude of all associations between adiposity and remaining adipokines.

CONCLUSIONS

Increasing adiposity contributes to a worsening imbalance of pro- and anti-inflammatory adipokines over time, in which leptin may have an important role as a key mediator of metabolic disease risk in Mexican Americans.

The association of IgA deficiency on infection rate, self-perceived health, and levels of C-reactive protein in healthy blood donors

The clinical importance of immunoglobulin A (IgA) deficiency in otherwise healthy individuals is not well described. We aimed to investigate the self-reported mental and physical health and the risk of infection in IgA-deficient blood donors compared to healthy control blood donors. Infectious events, recorded in public health registries either as prescriptions filled of any antimicrobial medicine or as hospital infections, were compared between 177 IgA-deficient blood donors and 1770 control blood donors. A subset of the IgA-deficient donors were further characterized by self-reported health (Short Form-12, n = 28) and circulating C-reactive protein (CRP) (n = 10). IgA-deficient individuals had lower self-reported mental health (p = 0.01) and higher CRP (p < 0.05). A strong trend was found regarding prescription of antimicrobial medicine (hazard ratio = 1.19, p = 0.05). No association was found with hospital infections (hazard ratio = 1.02, p = 0.95) or self-reported physical health (p = 0.86). IgA-deficient blood donors have impaired self-reported mental health, enhanced inflammation and possibly an increased risk of infection. Despite these findings, this study does not provide sufficient evidence to warrant specific health precautions for donors with IgA deficiency.

Periodontal disease and its connection to systemic biomarkers of cardiovascular disease in young American Indian/Alaskan natives

BACKGROUND

Periodontal disease has been shown to be associated with cardiovascular disease (CVD). No known studies evaluate the relationship between periodontal disease status and biomarkers of CVD risk in the American Indian/Alaskan Native (AI/AN) population despite their disproportionately high rates of poor oral health and cardiovascular disease-related outcomes. This study compared levels of interleukin (IL)-6 and C-reactive protein (CRP) across increasing severity of periodontal disease status among younger adults between the ages of 21 and 43 years.

METHODS

Plasma levels of IL-6 and CRP were measured in adult participants (ages 21 to 43 years) as part of a study of periodontal disease and CVD risk among an AI/AN population in southern California (n = 59). Periodontal evaluations were performed and disease status was classified into three categories based on highest probing depth (none/mild: < 3 mm; moderate: 4 to 5 mm; severe: ≥6 mm). Participants with known systemic disease or active infection were excluded.

RESULTS

Severe periodontitis was significantly associated with increased levels of IL-6 compared with those with none or mild periodontitis before controlling for other variables (P = 0.02), but lacked significance after controlling for sex, BMI, smoking status, and high-density lipoprotein (P = 0.09). Moderate periodontal disease was positively associated with IL-6 levels after controlling for potential confounders (P = 0.01). Periodontal status was not associated with CRP, before or after adjusting for covariates.

CONCLUSIONS

In this otherwise healthy AI/AN adult sample, moderate periodontal disease compared with none or mild periodontal disease was associated with increased levels of IL-6. High levels of CRP found in this population warrant further research.

Independent association of resting energy expenditure with blood pressure: confirmation in populations of the African diaspora

BACKGROUND

Obesity is a major risk factor for hypertension, however, the physiologic mechanisms linking increased adiposity to elevations in blood pressure are not well described. An increase in resting energy expenditure (REE) is an obligatory consequence of obesity. Previous survey research has demonstrated that REE is an independent predictor of blood pressure, and eliminates the co-linear association of body mass index. This observation has received little attention and there have been no attempts to provide a causal explanation.

METHODS

At baseline in an international comparative study on obesity, 289 participants aged 25-44 were recruited from communities in the US, the Seychelles, Ghana and South Africa and had REE measured with indirect calorimetry. All participants were thought to be free of major illness.

RESULTS

In multivariate regression models, both systolic and diastolic blood pressure were positively associated with REE (p < 0.01), while body mass index and fat mass were negatively correlated with systolic blood pressure (p < 0.01, and p < 0.05 respectively), but not diastolic blood pressure.

CONCLUSIONS

These data confirm previous reports and suggest that a common physiologic abnormality links REE and blood pressure. Elevated catecholamines, a putative metabolic characteristic of obesity, is a possible candidate to explain this association. The direct role of excess adipose tissue is open to question.

A randomized, placebo-controlled trial of beloranib for the treatment of hypothalamic injury-associated obesity

AIMS

Hypothalamic injury-associated obesity (HIAO) results from damage to the hypothalamus that often occurs with surgical removal/radiation therapy of tumours in the hypothalamic region, such as craniopharyngioma. There is currently no rigorously studied pharmaceutical treatment for the intractable weight gain and cardiometabolic consequences that occur in patients with HIAO. We aimed to assess efficacy, safety and tolerability of beloranib treatment for 4 to 8 weeks in patients with HIAO.

MATERIALS AND METHODS

This Phase 2a, double-blind, placebo-controlled study included 14 patients with HIAO, randomized to receive beloranib 1.8 mg or placebo subcutaneously twice weekly for 4 weeks with an optional 4-week open-label extension in which all patients received beloranib. The primary endpoint was change in weight from baseline to Week 4.

RESULTS

Participants were 64% female, with a mean (SD) age of 32 (9) years, BMI of 43 (7) kg/m² and weight of 126 (22) kg. Compared with placebo (N = 4), beloranib 1.8 mg (N = 8) resulted in a mean (95% CI) difference in weight of -3.2 (-5.4, -0.9) kg after 4 weeks. Weight loss continued through the 8 weeks in patients randomized to beloranib (mean -6.2 [-8.2, -4.1] kg). Beloranib treatment was associated with improvements in high-sensitivity CRP. Adverse events were mild to moderate. No patients who received beloranib discontinued treatment.

CONCLUSION

Beloranib treatment resulted in progressive weight loss in patients with HIAO that was comparable to that observed with beloranib in patients with exogenous obesity. These findings indicate a novel mechanism for treating obesity in patients with HIAO.

Adiponectin, lipids and atherosclerosis

PURPOSE OF REVIEW

Adiponectin is an adipokine with anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing properties. Several factors may influence adiponectin levels, such as genetic polymorphisms, obesity / body fat distribution, diet and exercise as well as cardiovascular risk factors such as sleep deprivation and smoking as well as medications. Adiponectin has been proposed as a potential prognostic biomarker and a therapeutic target in patients with cardiometabolic diseases.

RECENT FINDINGS

This narrative review discusses the associations of adiponectin with obesity-related metabolic disorders (metabolic syndrome, nonalcoholic fatty liver disease, hyperuricaemia and type 2 diabetes mellitus). We also focus on the links between adiponectin and lipid disorders and with coronary heart disease and noncardiac vascular diseases (i.e. stroke, peripheral artery disease, carotid artery disease, atherosclerotic renal artery stenosis, abdominal aortic aneurysms and chronic kidney disease). Further, the effects of lifestyle interventions and drug therapy on adiponectin levels are briefly reviewed.

SUMMARY

Based on available data, adiponectin represents a multifaceted biomarker that may beneficially affect atherosclerosis, inflammation and insulin resistance pathways. However, there are conflicting results with regard to the associations between adiponectin levels and the prevalence and outcomes of cardiometabolic diseases. Further research on the potential clinical implications of adiponectin in the diagnosis and treatment of such diseases is needed.

Potential novel biomarkers of cardiovascular dysfunction and disease: cardiotrophin-1, adipokines and galectin-3

Cardiovascular disease is one of the main burdens of healthcare systems worldwide. Nevertheless, assessing cardiovascular risk in both apparently healthy individuals and low/high-risk patients remains a difficult issue. Already established biomarkers (e.g. brain natriuretic peptide, troponin) have significantly improved the assessment of major cardiovascular events and diseases but cannot be applied to all patients and in some cases do not provide sufficiently accurate information. In this context, new potential biomarkers that reflect various underlying pathophysiological cardiac and vascular modifications are needed. Also, a multiple biomarker evaluation that shows changes in the cardiovascular state is of interest. This review describes the role of selected markers of vascular inflammation, atherosclerosis, atherothrombosis, endothelial dysfunction and cardiovascular fibrosis in the pathogenesis and prognosis of cardiovascular disease: the potential use of cardiotrophin-1, leptin, adiponectin, resistin and galectin-3 as biomarkers for various cardiovascular conditions is discussed.

Leptin concentration and risk of coronary heart disease and stroke: A systematic review and meta-analysis

Background and purpose

Although high leptin concentration has been shown to be correlated with established vascular risk factors, epidemiologic studies have reported inconclusive results on the association between leptin and cardiovascular diseases (CVD). Therefore, a meta-analysis was performed to evaluate this issue.

Methods

We searched Pubmed, Embase, and the Cochrane Library from their inception to Jan 2016 for both case-control and cohort studies that assessed leptin concentration and CVD risk. Reports with odds ratio (OR), risk ratio (RR) and corresponding 95% confidence intervals (CI) were considered. The data were extracted by two investigators independently.

Results

A total of 13 epidemiologic studies totaling 4257 CVD patients and 26710 controls were included. A significant inverse association was shown between leptin and coronary heart disease (CHD), with an overall OR of 1.16 (95% CI: 1.02–1.32), but not for stroke (OR = 1.21, 95% CI 0.98–1.48) under sociodemographic adjustment. Further adjustment for additional cardiovascular risk factors resulted in ORs of 1.16 (95% CI 0.97–1.40) for CHD and 1.10 (95% CI 0.89–1.35) for stroke. The findings remained when analyses were restricted to high-quality studies and indicated OR estimates of 1.07 (95% CI 0.96–1.19) for CHD and 0.98 (95% CI 0.76–1.25) for stroke. In a subgroup meta-analysis, a high leptin level was not independently associated with CHD in both females (OR = 1.03, 95% CI 0.86–1.23) and males (OR = 1.09, 95% CI 0.95–1.26) or with stroke in both females (OR = 1.13, 95% CI 0.87–1.47) and males (OR = 0.80, 95% CI 0.59–1.09). There was no significant publication bias as suggested by Egger test outcomes.

Conclusions

Our findings indicate that high leptin levels may not be associated with risks of CHD and stroke. Further large, well-designed prospective cohort studies are needed to fully evaluate the role of leptin on the risk of CVD.

Increased leptin/adiponectin ratio relates to low-normal thyroid function in metabolic syndrome

Background

Low-normal thyroid function within the euthyroid range may contribute to increased atherosclerosis susceptibility. The leptin/adiponectin (L/A) ratio is associated with cardiovascular disease and reflects adipose tissue dysfunction. Relationships of the L/A ratio with low-normal thyroid function are unknown.

Methods

Relationships of thyroid stimulating hormone (TSH) and free thyroxine (free T₄) with leptin, adiponectin and the L/A ratio in euthyroid subjects were documented in 67 fasting subjects with metabolic syndrome (Mets) and 86 euthyroid subjects without MetS (TSH and free T₄ levels within the institutional reference range).

Results

Neither plasma leptin nor adiponectin was significantly correlated with TSH or free T₄ in subjects with and without MetS. In the whole group, high sensitivity C-reactive protein (hs-CRP) was positively correlated with the L/A ratio (r = 0.485, P < 0.001). Notably, the L/A ratio was positively correlated with TSH in subjects with MetS (r = 0.252, P = 0.040) but not in subjects without MetS (r = −0.068, P = 0.54; interaction term, P = 0.027). In MetS subjects, the L/A ratio remained positively related with TSH after adjustment for age, sex, diabetes status, hs-CRP and the use of antihypertensive and glucose lowering medication (β = 0.283, P = 0.018), as well as after adjustment for individual MetS components (β = 0.294, P = 0.020).

Conclusions

In the context of MetS, a higher TSH within the euthyroid range confers an increased L/A ratio, a proposed marker of atherosclerosis susceptibility and adipocyte dysfunction.

Asymptomatic hyperuricemia is not an independent risk factor for cardiovascular events or overall mortality in the general population of the Busselton Health Study

Background

To investigate the impact of uric acid (UA) levels on cardiovascular disease and mortality at a population level.

Methods

Prospective analysis of baseline serum UA measurement and 15 year follow-up data from the Busselton Health Survey (n = 4,173), stratified by existence or absence of baseline cardiovascular disease. Outcomes were ascertained from state-wide hospital discharge and mortality registries. Cox regression produced adjusted hazard ratios (HR) for UA level as continuous and categorical (low, medium, high) predictor for cardiovascular events (CVE) and mortality. Gout was defined as a patient’s self-reported history of gout.

Results

After age and gender adjustment each 0.1 mmol/L rise in UA level was associated with increased mortality (HR 1.19, CI 1.04–1.36), cardiovascular mortality (HR 1.27, CI 1.03–1.57) and first CVE (HR 1.28, CI 1.13–1.44) in participants with no history of CVE. Adjustment for behavioural and biomedical risk factors of cardiovascular disease attenuated these associations. Results for participants with a history of CVE and for a subset of 1,632 participants using UA levels (2–6 measurements) averaged over time were similar. The overall prevalence of hyperuricemia was 10.7%. When stratified by history of gout, UA level was significantly associated with increased risk of cardiovascular mortality only in participants with a history of CVE (HR 2.13, CI 1.03–4.43).

Conclusions

Despite the considerable prevalence of hyperuricemia in 10.7% of the population, single or time averaged measures of UA were not independently predictive of incident cardiovascular disease or mortality. Hyperuricemia did associate with an increased risk of cardiovascular death only in participants with gout and existing cardiovascular disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-016-0421-1) contains supplementary material, which is available to authorized users.

Obesity and stroke: Can we translate from rodents to patients?

Obesity is a risk factor for stroke and is consequently one of the most common co-morbidities found in patients. There is therefore an identified need to model co-morbidities preclinically to allow better translation from bench to bedside. In preclinical studies, both diet-induced and genetically obese rodents have worse stroke outcome, characterised by increased ischaemic damage and an altered inflammatory response. However, clinical studies have reported an 'obesity paradox' in stroke, characterised by reduced mortality and morbidity in obese patients. We discuss the potential reasons why the preclinical and clinical studies may not agree, and review the mechanisms identified in preclinical studies through which obesity may affects stroke outcome. We suggest inflammation plays a central role in this relationship, as obesity features increases in inflammatory mediators such as C-reactive protein and interleukin-6, and chronic inflammation has been linked to worse stroke risk and outcome.

Abdominal Adiposity Distribution Quantified by Ultrasound Imaging and Incident Hypertension in a General Population

Abdominal obesity is a major risk factor for hypertension. However, different distributions of abdominal adipose tissue may affect hypertension risk differently. The main purpose of this study was to explore the association of subcutaneous abdominal adipose tissue (SAT) and visceral adipose tissue (VAT) with incident hypertension in a population-based setting. We hypothesized that VAT, rather than SAT, would be associated with incident hypertension. VAT and SAT were determined by ultrasound imagining in 3363 randomly selected Danes (mean age 49 years, 56% women, mean body mass index 25.8 kg/m 2 ). We constructed multiple logistic regression models to compute standardized odds ratios with 95% confidence intervals per SD increase in SAT and VAT. Of the 2119 normotensive participants at baseline, 1432, with mean SAT of 2.8 cm and mean VAT of 5.7 cm, returned 5 years later for a follow-up examination and among them 203 had developed hypertension. In models including both VAT and SAT, the Framingham Hypertension Risk Score variables (age, sex, smoking status, family history of hypertension, and baseline blood pressure) and glycated hemoglobin, odds ratio (95% confidence interval) for incident hypertension for 1 SD increase in VAT and SAT was 1.27 (1.08–1.50, P =0.004) and 0.97 (0.81–1.15, P =0.70), respectively. Adjusting for body mass index instead of SAT attenuated the association between VAT and incident hypertension, but it was still significant (odds ratio, 1.22 [1.01–1.48, P =0.041] for each SD increase in VAT). In conclusion, ultrasound-determined VAT, but not SAT, was associated with incident hypertension in a random sample of Danish adults.

Metabolic Vascular Syndrome: New Insights into a Multidimensional Network of Risk Factors and Diseases

BACKGROUND

Since 1981, we have used the term metabolic syndrome to describe an association of a dysregulation in lipid metabolism (high triglycerides, low high-density lipoprotein cholesterol, disturbed glucose homeostasis (enhanced fasting and/or prandial glucose), gout, and hypertension), with android obesity being based on a common soil (overnutrition, reduced physical activity, sociocultural factors, and genetic predisposition). We hypothesized that main traits of the syndrome occur early and are tightly connected with hyperinsulinemia/insulin resistance, procoagulation, and cardiovascular diseases.

METHODS

To establish a close link between the traits of the metabolic vascular syndrome, we focused our literature search on recent original work and comprehensive reviews dealing with the topics metabolic syndrome, visceral obesity, fatty liver, fat tissue inflammation, insulin resistance, atherogenic dyslipidemia, arterial hypertension, and type 2 diabetes mellitus.

RESULTS

Recent research supports the concept that the metabolic vascular syndrome is a multidimensional and interactive network of risk factors and diseases based on individual genetic susceptibility and epigenetic changes where metabolic dysregulation/metabolic inflexibility in different organs and vascular dysfunction are early interconnected.

CONCLUSION

The metabolic vascular syndrome is not only a risk factor constellation but rather a life-long abnormality of a closely connected interactive cluster of developing diseases which escalate each other and should continuously attract the attention of every clinician.

Risk Stratification for Primary Prevention of Coronary Artery Disease: Roles of C-Reactive Protein and Coronary Artery Calcium

Risk stratification of individuals at risk for atherosclerotic cardiovascular disease (ASCVD) plays an important role in primary prevention of cardiovascular disease. In addition to risk scores derived from conventional cardiovascular risk factors, high sensitivity C-reactive protein (hs-CRP) and coronary artery calcium (CAC) have emerged as two of the widely accepted non traditional risk factors for atherosclerotic disease that have shown incremental prognostic value in predicting cardiovascular events. This review systematically assesses the role of hs-CRP and CAC in various studies and demonstrates meta-analyses of the incremental prognostic value of hs-CRP and CAC in identifying patients at risk of future CVD events. Compared with this, CAC showed better incremental prognostic value and might be a better indicator of ASCVD risk in asymptomatic adults.

Overweight and Obesity in Young Adulthood and the Risk of Stroke: a Meta-analysis

BACKGROUND

A systematic review assessing the association between overweight and obesity in young adulthood and stroke risk is lacking. Therefore, we conducted a meta-analysis to evaluate the association between overweight and obesity in young adulthood and stroke risk.

METHODS

We systematically searched PubMed and Embase databases for related studies of human subjects in the English language. Two investigators independently selected original studies in a 2-step process. Fixed- and random-effects models were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses were also performed.

RESULTS

Eight studies met the inclusion criteria. The pooled adjusted RR of stroke was 1.36 (95% CI: 1.28-1.44) for overweight in young adulthood and 1.81 (95% CI: 1.45-2.25) for obesity in young adulthood. In subgroup analyses, overweight and obesity in young adulthood increased the risk of stroke in most groups, except for the group of stroke subtype. For ischemic stroke, the adjusted RR was 1.40 (95% CI: 1.24-1.58) for overweight in young adulthood and 1.78 (95% CI: 1.003-3.16) for obesity in young adulthood, whereas adjusted RR for hemorrhagic stroke was 1.25 (95% CI: .83-1.90) for overweight in young adulthood and 1.80 (95% CI: .97-3.35) for obesity in young adulthood.

CONCLUSIONS

Overweight and obesity in young adulthood are associated with an increased risk of stroke, probably, independent of other cardiovascular risk factors. The risk effect gradually increases with increasing body weight.

Diabetes mellitus related biomarker: The predictive role of growth-differentiation factor-15

Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine, which belongs to super family of the transforming growth factor beta. GDF-15 is widely presented in the various cells (macrophages, vascular smooth muscle cells, adipocytes, cardiomyocytes, endothelial cells, fibroblasts), tissues (adipose tissue, vessels, tissues of central and peripheral nervous system) and organs (heart, brain, liver, placenta) and it plays an important role in the regulation of the inflammatory response, growth and cell differentiation. Elevated GDF-15 was found in patients with established CV diseases including hypertension, stable coronary artery disease, acute coronary syndrome, myocardial infarction, ischemic and none ischemic-induced cardiomyopathies, heart failure, atrial fibrillation, as well as stroke, type two diabetes mellitus (T2DM), chronic kidney disease, infection, liver cirrhosis, malignancy. Therefore, aging, smoking, and various environmental factors, i.e. chemical pollutants are other risk factors that might increase serum GDF-15 level. Although GDF-15 has been reported to be involved in energy homoeostasis and weight loss, to have anti-inflammatory properties, and to predict CV diseases and CV events in general or established CV disease population, there is no large of body of evidence regarding predictive role of elevated GDF-15 in T2DM subjects. The mini review is clarified the role of GDF-15 in T2DM subjects.

Association between high sensitivity C-Reactive protein and prevalence of asymptomatic carotid artery stenosis

INTRODUCTION

Inflammation plays a key role in the pathophysiology of atherosclerosis. Little is known about the association between high sensitivity C-reactive protein (hs-CRP) especially long-term hs-CRP and asymptomatic carotid artery stenosis (ACAS) in healthy Chinese adults. The aim of this study was to assess the relationship between hs-CRP levels and the prevalence of ACAS in a Chinese community-based cohort.

METHODS

A sample of 5349 participants aged ≥ 40 years (40.36% women) were enrolled in this study, all without preexisting stroke. Ultrasonography of the bilateral carotid arteries was performed for the evaluation of carotid stenosis. Participants were stratified into three groups according to hs-CRP levels. We used both baseline (hs-CRP levels analyzed during 2010) and average hs-CRP values for the last four years (the average of hs-CRP levels analyzed at the year of 2006, 2008 and 2010) in the analysis. Multivariable logistic regression models were used to analyze the association between hs-CRP levels and ACAS.

RESULTS

A total of 356 (6.66%) subjects showed evidence of ACAS. Multivariate analysis showed that both baseline and average hs-CRP values for the last four years were independent indicators for the presence of ACAS (P for trend = 0.007, 0.001, respectively). Stratified by age and sex, higher baseline hs-CRP levels were associated with ACAS in old adults (≥ 60 y) (multivariate-adjusted, odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01-1.05) and male (multivariate-adjusted, OR = 1.03, 95%CI: 1.01-1.05), but not in middle-aged adults (40-59 y) and female. Similarly, higher average hs-CRP values for the last four years were associated with ACAS in old adults and male, but not in middle-aged adults and female.

CONCLUSION

Both baseline and chronic elevation of serum hs-CRP were associated with ACAS, especially in older or male adults. hs-CRP might be used as a useful marker and a potential therapeutic target for carotid atherosclerosis.