Relationship among the leptin-to-adiponectin ratio, systemic inflammation, and anisocytosis in well-controlled type 2 diabetic patients with atherosclerotic cardiovascular disease

Background: Previous studies have shown that red blood cell distribution width (RDW) is an independent predictor of poor prognosis in type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). The mechanisms underlying increased anisocytosis in patients with T2D and confirmed ASCVD remain poorly understood. Aims: We sought to evaluate the relationship among the leptin-to-adiponectin ratio, systemic low -grade inflammation, and RDW in optimally treated patients with T2D and established ASCVD. Methods: A total of 68 patients, aged 47 to 85 years (mean [SD], 65.3 [6.8] years) and including 21 women (30.9%), were enrolled and grouped according to median RDW into those with RDW < 13.5% (n = 33) and those with RDW ≥13.5% (n = 35). Results: Patients with RDW ≥13.5% had a significantly higher median (interquartile range [IQR]) serum leptin-to-adiponectin ratio (1.7 [0.49–2.3] ng/μg vs 0.66 [0.31–1.25] ng/μg; P = 0.04) and median (IQR) tumor necrosis factor α levels (1.58 [1.42–1.97] pg/ml vs 1.39 [1.18–1.57] pg/ml; P = 0.02). There were no significant differences in the concentrations of other inflammatory markers. The leptin-to-adiponectin ratio (r = 0.25; P = 0.04) and levels of tumor necrosis factor α (r = 0.32; P = 0.01) and soluble intercellular adhesion molecule 1 (r = 0.31; P = 0.01) were positively correlated with RDW, which was confirmed by univariate linear regression analysis. A multivariable regression model, which included demographic, clinical, and laboratory data, showed that white blood cell count (β = 0.25; 95% CI, 0.05–0.45; P = 0.01), soluble intercellular adhesion molecule 1 levels (β = 0.21; 95% CI, 0.02–0.41; P = 0.03), and mean corpuscular hemoglobin concentration (MCHC), (β = –0.48; 95% CI, 0.67 to –0.28; P < 0.001) were independent predictors of RDW in our patients. Conclusions: In well-controlled patients with T2D and ASCVD, the RDW values are associated with leptin-to-adiponectin imbalance and selected inflammatory markers

Association of serum levels of lipoprotein A-I and lipoprotein A-I/A-II with high on-treatment platelet reactivity in patients with ST-segment elevation myocardial infarction

Objective: High-density lipoproteins (HDLs) are a very heterogeneous group of particles. Little is known about the impact of their subfractions including lipoprotein A-I (LpA-I) and lipoprotein A-I/A-II (LpA-I/A-II) on platelet function and high on-treatment platelet reactivity (HPR), particularly in the acute phase of ST-segment elevation myocardial infarction (STEMI). The aim of the study was to evaluate the relationship between serum levels of LpA-I and LpA-I/A-II and HPR in STEMI patients. Methods: Fifty-two consecutive STEMI patients (26.9% women, mean age 60.6±9.1 years) were enrolled into this study. Clinical and demographic data were collected and HDL subfractions were measured by rocket immunoelectrophoresis. Platelet reactivity was assessed using light transmission aggregometry and quantitative flow cytometry. Results: We found a positive correlation between platelet aggregation after both ADP-5 and ADP-20 stimulation and serum level of LpA-I. Compared with subjects with satisfactory platelet response to clopidogrel, patients with HPR had 32.44% higher serum level of LpA-I (p=0.021). On the other hand, patients with HPR assessed by ADP-5 stimulation had 22.13% lower serum level of LpA-I/A-II (p=0.040). Regression analysis showed that LpA-I [odds ratio (OR) 1.03; 95% confidence interval (CI) 1-1.07; p=0.049] and current smoking (OR 0.18; 95% CI 0.04-0.81; p=0.025) were independent predictors of HPR. With receiver operating characteristic (ROC) curve analysis, we designated the cut-off point at serum level of 57.52 mg/dL for LpA-I for predicting HPR (AUC=0.71, p=0.010). Conclusion: This study showed that higher serum level of LpA-I measured in the acute phase of STEMI is an independent risk factor for HPR. Our study is the first to demonstrate an important and distinct activity of LpA-I and LpA-I/A-II that can prove pleiotropic and different functions of HDL subfractions in acute STEMI. (Anatol J Cardiol 2018; 19: 374-81

Association between carotid-femoral pulse wave velocity and overall cardiovascular risk score assessed by the SCORE system in urban Polish population

Background: The Systemic COronary Risk Estimation (SCORE) system is recommended for the assessment of cardiovascular  disease (CVD) death risk in individuals free of CVD.  Aims: We sought to determine the association between carotid-femoral pulse wave velocity (CFPWV) and SCORE.  Methods: The study involved 1008 Krakow residents, and a random subsample of 3424 men and 3205 women who participated in Wave 2 of the Polish part of the Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study. At baseline we performed a medical interview, physical examination, evaluation of present comorbidities, medications using standardised methods. A follow-up of 4.9 years included measurement of CFPWV using an automatic, computerised Complior® system.  Results: Final analysis included 720 patients (378 women), aged 58.5 ± 6.5 years at baseline. In 488 individuals without his- tory of CVD and/or diabetes, SCORE was calculated. Median CFPWV was higher (p = 0.002) in men (12.5 m/s; interquartile range [IQR] 10.3–15.7) than in women (11.7 m/s; IQR 10.1–13.7). High CFPWV ( > 10 m/s) was observed in 270 men (78.9%) and in 285 women (75.4%). We observed a strong association between high CVD risk (SCORE ≥ 5%) and high CFPWV (odds ratio 2.29; 95% confidence interval 1.17–4.46). The CFPWV cut-off value to differentiate between patients with low and high CVD risk was 11.7 m/s (with 58.6% sensitivity and 71.3% specificity, AUC = 0.68).  Conclusions: Our study is the first to describe the distribution of CFPWV in the adult Polish population. SCORE ≥ 5% pre- dicted high CFPWV in 4.9 years of follow-up, which was independent of other risk factors. CFPWV > 11.7 m/s was most valid in relation to high CVD risk.

Response to the letter concerning the article : "association between carotid-femoral pulse wave velocity and overall cardiovascular risk score assessed by the SCORE system in urban Polish population"

Background: The Systemic COronary Risk Estimation (SCORE) system is recommended for the assessment of cardiovascular  disease (CVD) death risk in individuals free of CVD.  Aims: We sought to determine the association between carotid-femoral pulse wave velocity (CFPWV) and SCORE.  Methods: The study involved 1008 Krakow residents, and a random subsample of 3424 men and 3205 women who participated in Wave 2 of the Polish part of the Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study. At baseline we performed a medical interview, physical examination, evaluation of present comorbidities, medications using standardised methods. A follow-up of 4.9 years included measurement of CFPWV using an automatic, computerised Complior® system.  Results: Final analysis included 720 patients (378 women), aged 58.5 ± 6.5 years at baseline. In 488 individuals without his- tory of CVD and/or diabetes, SCORE was calculated. Median CFPWV was higher (p = 0.002) in men (12.5 m/s; interquartile range [IQR] 10.3–15.7) than in women (11.7 m/s; IQR 10.1–13.7). High CFPWV ( > 10 m/s) was observed in 270 men (78.9%) and in 285 women (75.4%). We observed a strong association between high CVD risk (SCORE ≥ 5%) and high CFPWV (odds ratio 2.29; 95% confidence interval 1.17–4.46). The CFPWV cut-off value to differentiate between patients with low and high CVD risk was 11.7 m/s (with 58.6% sensitivity and 71.3% specificity, AUC = 0.68).  Conclusions: Our study is the first to describe the distribution of CFPWV in the adult Polish population. SCORE ≥ 5% pre- dicted high CFPWV in 4.9 years of follow-up, which was independent of other risk factors. CFPWV > 11.7 m/s was most valid in relation to high CVD risk.

Niedokarboksylowane białko macierzy Gla u pacjentów z zawałem serca z uniesieniem odcinka ST oraz przewlekłymi zespołami wieńcowymi

Introduction. Matrix Gla proteins (MGPs) are usually considered as natural inhibitors of soft tissue calcification in chronic inflammatory disorders. However, MGP levels in acute inflammation related to myocardial ischemia have been poorly investigated. This study aimed to compare the serum concentrations of uncarboxylated MGPs (ucMGPs) between patients with ST-segment elevation myocardial infarction (STEMI) vs. with chronic coronary syndromes (CCS) and to investigate the association between ucMGP concentration and an increased risk of major adverse cardiovascular events (MACE) in STEMI patients. Material and methods. 155 consecutive patients were enrolled (mean ± standard deviation age, 64 ± 13 years), including 80 patients with a first STEMI and 75 ones with CCS as controls. Blood samples were obtained within the first 24 h from hospital admission to evaluate ucMGP levels. Combination of MACE [all-cause mortality, heart failure (HF) within the first 30 days after myocardial infarction] was evaluated. Results. ucMGP levels were higher in patients with STEMI than in controls (2929 ± 96.5 ng/mL vs. 67.3 + 32.3 ng/mL; p &lt; 0.0001). A significant positive correlation between ucMGP and high-sensitivity C-reactive protein, troponin levels was found. Multivariate analysis showed that ucMGP was an independent associate of STEMI [odds ratio (OR) 1.39; confidence interval (CI): 0.78–2.14, p = 0.01]. Although ucMGP did not predict the combined MACE, however it was an independent associate of HF occurrence 30 days after STEMI (OR, 1.20; 95% CI: 1.07–1.30, p = 0.04). Conclusion. Elevated ucMGP levels in patients with STEMI indicate that some MGPs may be involved in disorders related not only to chronic but also acute inflammatory states.Wprowadzenie. Białka macierzy Gla (MGP) uważa się za naturalne inhibitory wapnienia tkanek miękkich w przewlekłych stanach zapalnych. Jednak stężenie MGP w ostrym procesie zapalnym towarzyszącym zawałowi serca zostało słabo zbadane. Celem tego badania było porównanie stężeń niedokarboksylowanego MGP (ucMGP) w surowicy u pacjentów z zawałem serca z uniesieniem odcinka ST (STEMI) ze stężeniami ucMGP u osób z przewlekłymi zespołami wieńcowymi (CCS) oraz zbadanie związku między stężeniem ucMGP a podwyższonym ryzykiem poważnych niepożądanych zdarzeń sercowo-naczyniowych (MACE) u pacjentów ze STEMI. Materiał i metody. Do badania włączono 155 kolejnych pacjentów (średnio ± odchylenie standardowe 64 ± 13 lat), w tym 80 pacjentów ze STEMI jako pierwszą manifestacją choroby wieńcowej oraz 75 pacjentów z CCS jako grupą kontrolną. Próbki krwi pobrano w pierwszych 24 h od przyjęcia do szpitala w celu oceny stężenia ucMGP. Oceniono MACE złożony ze śmiertelności ogólnej oraz niewydolności serca (HF) w pierwszych 30 dniach po zawale serca. Wyniki. Stężenie ucMGP były istotnie wyższe u pacjentów ze STEMI niż w grupie kontrolnej (2929 ± 96,5 ng/ml vs. 67,3 ± 32,3 ng/ml; p < 0,0001). Stwierdzono istotną dodatnią korelację między ucMGP, białkiem C-reaktywnym oznaczanym metodą wysokoczułą oraz stężeniem troponiny sercowej. Analiza wieloczynnikowa wykazała, że ucMGP był niezależnie związany z wystąpieniem STEMI (iloraz szans [OR] 1,39; przedział ufności [CI]: 0,78–2,14; p = 0,01). Jednakże stężenie ucMGP nie było predyktorem złożonego MACE, ale wiązało się niezależnie z wystąpieniem HF 30 dni po STEMI (OR, 1,20; 95% CI: 1,07–1,30; p = 0,04). Wnioski. Podwyższone stężenie ucMGP u pacjentów ze STEMI wskazuje, że niektóre MGP mogą uczestniczyć także w ostrych stanach zapalnych