Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease

Abstract

Introduction: Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.

Methods: Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke.

Results: In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64–6.90; p = 0.001) and ACS or stroke (HR 1.95; 95%CI 1.29–2.96; p = 0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71–0.85) to 0.81 (0.74–0.88) and improved classification (NRI 0.36; 95%CI 0.13–0.60; p = 0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001–0.030; p = 0.031).

Conclusions: High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated.

Key messages

• Leptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors.

• High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors.

• The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.

Keywords:

• Cardiac death
• coronary artery disease
• heart failure
• leptin

Acknowledgements

The authors wish to acknowledge the technical assistance of Ms Pirkko Huikuri, Ms Sari Kaarlenkaski, Ms Päivi Kastell and Ms Päivi Koski. This work was supported by a grant from the Finnish Funding Agency for Technology and Innovation (TEKES, Helsinki, Finland) and the Medical Research Center Oulu Doctoral Programme (MRC Oulu DP).

Disclosure statement

The authors disclose no conflicts of interest.

Additional information

Funding

This work was supported by a grant from the Finnish Funding Agency for Technology and Innovation (TEKES, Helsinki, Finland) and the Medical Research Center Oulu Doctoral Programme (MRC Oulu DP).