This study was designed to evaluate the relationship between plasma leptin and prognosis in patients with angiographically confirmed coronary atherosclerosis.
Background
Experimental studies suggest that leptin, an adipose tissue-derived hormone, exerts important cardiovascular effects.
Methods
Study subjects were recruited prospectively from a cohort of patients undergoing clinically indicated coronary angiography (n = 382). The median duration of follow-up was four years. Follow-up information was available for 361 patients.
Results
The combined end point of cardiac death, myocardial infarction (MI), cerebrovascular accident, or re-vascularization occurred in 44 subjects. In the simple Cox model, leptin had a significant (p < 0.001) non-linear/cubic univariate relationship with the combined end point. Other variables associated with prognosis in the univariate analysis were body mass index (BMI), prior MI, insulin resistance, C-reactive protein (CRP), fibrinogen, and number of coronary vessels with >50% stenosis. A positive relationship between leptin and prognosis was also seen when leptin levels were split by quintiles, with a hazard ratio of 6.46 for the highest quintile. The only two variables significantly associated with the combined end point in the multivariate Cox model were leptin (p = 0.004) and number of coronary vessels with >50% stenosis (p < 0.001). A similar relationship between leptin and prognosis was observed when leptin was adjusted for BMI.
Conclusions
In patients with angiographically confirmed coronary atherosclerosis, leptin is a novel predictor of future cardiovascular events independent of other risk factors, including lipid status and CRP.
Abbreviations and acronyms
BMI
body mass index
CABG
coronary artery bypass grafting
CRP
C-reactive protein
CVA
cerebrovascular accident
HDL
high-density lipoprotein
LDL
low-density lipoprotein
MI
myocardial infarction
PCI
percutaneous coronary intervention
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This study was supported by Mayo Foundation grants HL-61560, HL-65176, HL-70302, and MO1-RR00585.