Prognostic value of adipokines in patients with myocardial infarction and glucose metabolism disorders

Aims.
To evaluate the prognostic value of adipokines in patients with myocardial infarction (MI) and various glucose metabolism disorders.
Materials and Methods.
Consecutive patients aged ?80 years and diagnosed with MI (380 patients, 63.4% males) were examined. The patients were classified into four groups: I, with normal glucose tolerance; II, with prediabetes; III and IV - with newly detected and previously diagnosed type 2 diabetes mellitus, respectively. Levels of insulin, C-peptide and cortisol during glucose tolerance test and basal levels of apolipoproteins AI, B100, leptin and adiponectin were determined in 113 patients with Q MI. Cardiovascular events were analysed for the next 2 years after MI. Logistic regression analysis was used to identify the risk factors of poor prognosis after MI.
Results.
Elevated levels of leptin with decreased levels of adiponectin were observed in all MI patients independent of the degree of glucose metabolism disturbance. A linear trend of leptin level increase was observed starting from group I to group IV (Jonckheere?s test: J=2218.0; z=3.411; р=0.001). Multiple regression analysis showed that the basal insulin level was an independent predictor of death during the 2 years after MI (OR=0.639; р=0.033). MI prior to hospitalisation (OR=5.633; р=0.013), basal hypercortisolaemia (OR=5.435; р=0.016), glycaemia (OR=1.213; р=0.023) and heart rate (OR=1.051; р=0.032) on admission were associated with the occurrence of repeated MI. Leptin levels (OR=1.018; р=0.031) and creatine kinase-MB fraction (OR=1.009; р=0.018) were risk factors of the occurrence of the combined end-point of cardiovascular events.
Conclusion.
An imbalance of adipokines was observed in MI patients regardless of the presence of glucose disorders. The levels of leptin, glycaemia, insulin and basal hypercortisolaemia were significantly associated with the occurrence of cardiovascular events during the late post-infarction period.

diabetes mellitus, leptin adiponectin, myocardial infarction, prognosis

1. Franklin K, Goldberg RJ, Spencer F, Klein W, Budaj A, Brieger D, Marre M, Steg PG, Gowda N, Gore JM; GRACE Investigators. Implications of diabetes in patients with acute coronary syndromes. The Global Registry of Acute Coronary Events. Arch Intern Med. 2004;164(13):1457-1463. doi:10.1001/archinte.164.13.1457

2. Пальцева ЕМ, Родина АВ, Константинова СВ, Ермаков НВ, Андреев ДА, Сыркин АЛ, Северин СЕ. Прогностические, диагностические и терапевтические перспективы применения адипонектина в качестве биомаркера при сердечно-сосудистых заболеваниях. Российский физиологический журнал им. И.М. Сеченова. 2009;95(10):1024-1040. [Paltsev AM, Rodina AV, Konstantinova SV, Ermakov NV, Andreev DA, Syrkin AL, Severin SE. Prognostiс, diagnostiс and therapeutic prospects of using adiponectine as a biomarker in cardiobascular diseases. Fiziologičeskij Žurnal imeni I.M. Sečenova. 2009;95(10):1024-1040.]

3. Чубриева СЮ, Глухов НВ, Зайчик АМ. Жировая ткань как эндокринный регулятор (обзор литературы). Вестник Санкт-Петербургского Университета. Серия 11: Медицина. 2008;(1):32-44. [Tchoubrieva SYu, Gloukhov NV, Zaichik AM. Adipose tissue as an endocrine organ (Review of literature). Vestnik Sankt-Peterburgskogo universiteta. Serii︠a︡ 11, Medit︠s︡ina. 2008;(1):32-44.]

4. Huang SS, Huang PH, Chen YH, Chiang KH, Chen JW, Lin SJ. Association of adiponectin with future cardiovascular events in patients after acute myocardial infarction. J Atheroscler Thromb. 2010;17(3):295-303. doi: 10.5551/jat.3533

5. Piestrzeniewicz K, Luczak K, Maciejewski M, Drozdz J. Low adiponectin blood concentration predicts left ventricular remodeling after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J. 2010;17(1):49-56. PMid:20104457

6. Persson J, Lindberg K, Gustafsson TP, Eriksson P, Paulsson-Berne G, Lundman P. Low plasma adiponectin concentration is associated with myocardial infarction in young individuals. J Intern Med. 2010;268(2):194-205. doi: 10.1111/j.1365-2796.2010.02247.x

7. Cavusoglu E, Ruwende C, Chopra V, Yanamadala S, Eng C, Clark LT, et al. Adiponectin is an independent predictor of all-cause mortality, cardiac mortality, and myocardial infarction in patients presenting with chest pain. Eur Heart J. 2006;27(19):2300-2309. doi: 10.1093/eurheartj/ehl153

8. Lindberg S, Pedersen SH, Møgelvang R, Bjerre M, Frystyk J, Flyvbjerg A, et al. Usefulness of adiponectin as a predictor of all cause mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol. 2012;109(4):492-496. doi: 10.1016/j.amjcard.2011.09.041

9. Söderberg S, Colquhoun D, Keech A, Yallop J, Barnes EH, Pollicino C, et al. Leptin, but not adiponectin, is a predictor of recurrent cardiovascular events in men: results from the LIPID study. Int J Obes (Lond). 2009;33(1):123-130. doi: 10.1038/ijo.2008.224

10. Wolk R, Berger P, Lennon RJ, Brilakis ES, Johnson BD, Somers VK. Plasma leptin and prognosis in patients with established coronary atherosclerosis. J Am Coll Cardiol. 2004;44(9):1819-1824. doi: 10.1016/j.jacc.2004.07.050

11. Wallander M, Söderberg S, Norhammar A. Leptin: a predictor of abnormal glucose tolerance and prognosis in patients with myocardial infarction and without previously known Type 2 diabetes. Diabet Med. 2008;25(8):949-955. doi: 10.1111/j.1464-5491.2008.02509.x

12. Ku IA, Farzaneh-Far R, Vittinghoff E, Zhang MH, Na B, Whooley MA. Association of low leptin with cardiovascular events and mortality in patients with stable coronary artery disease: the Heart and Soul Study. Atherosclerosis. 2011;217(2):503-508. doi: 10.1016/j.atherosclerosis.2010.10.047

13. Холматова КК, Дворяшина ИВ, Супрядкина ТВ. Различные варианты нарушений углеводного обмена и их влияние на течение инфаркта миокарда у пациентов г. Архангельска. Экология человека. 2013;(10):14-22. [Kholmatova KK, Dvoryashina IV, Supryadkina TV. Razlichnye varianty narusheniy uglevodnogo obmena i ikh vliyanie na techenie infarkta miokarda u patsientov g. Arkhangel'ska. Human Ecology. 2013;(10):14-22.]

14. Супрядкина ТВ. Влияние гормонально-метаболических нарушений на результаты аортокоронарного шунтирования у больных с различными вариантами накопления и распределения жировой ткани. Автореф. дисс…канд. мед. наук. Архангельск; 2010. 24 с. [Supryadkina TV. Vliyanie gormonal'no-metabolicheskikh narusheniy na rezul'taty aortokoronarnogo shuntirovaniya u bol'nykh s razlichnymi variantami nakopleniya i raspredeleniya zhirovoy tkani. [dissertation] Arkhangelsk; 2010. 24 p.]

15. Wahlqvist ML, Chuang SY. Paradoxes with weight disorders for health systems. Asia Pac J Clin Nutr. 2012;21(4):471-475. PMid:23017304

16. Canavan B, Salem RO, Schurgin S, Koutkia P, Lipinska I, Laposata M, et al. Effects of physiological leptin administration on markers of inflammation, platelet activation, and platelet aggregation during caloric deprivation. J Clin Endocrinol Metab. 2005;90(10):5779-5785. doi: 10.1210/jc.2005-0780