Abstract
Background/objectivesEarlier studies differ on whether serum leptin is associated with adverse or beneficial cardiac structure. We determined the association between serum leptin with subsequent cardiac structure and function. MethodsMESA is a multicenter longitudinal study of Black, White, Hispanic and Asian-American men and women. Cardiac MRI (CMR) was completed 6 to 8years after leptin was measured. Left ventricular (LV) mass and volumes were indexed to body surface area. Multivariable linear regression models were constructed to assess the associations between leptin and risk factor adjusted (age, race, gender, systolic blood pressure, anti-hypertensive usage, LDL, HDL, hyperlipidemia medication usage, diabetes, diabetic medication usage, chronic kidney disease, alcohol and tobacco use, adiponectin and BMI) CMR variables. ResultsRelative to participants in the lowest quintile of leptin concentration, participants in the highest quintile had a lower risk factor adjusted LV mass (−14g), LV mass index (−9g/m2), LV end diastolic volume index (LVEDVi) (−7ml/m2), LV end systolic volume index (LVESVi) (−3ml/m2) and stroke volume (−5ml) (all p≤0.05). On regression analysis, a doubling of leptin concentration was associated with lower LV mass (−2.5g±0.7g), LV mass index (−1.7±0.3g/m2), LVEDVi (−1.5±0.4ml/m2), LVESVi (−0.7±0.2ml/m2) and stroke volume (−1.0±0.5ml) (all p≤0.05). ConclusionsHigher leptin was associated with more favorable subsequent cardiac structure. Further study is needed to assess the prognostic and therapeutic implications of these observations.
Highlights
Reduced kidney function, approximated by elevated cystatin C, is associated with diastolic dysfunction, heart failure, and cardiovascular mortality; the precise mechanism(s) that account for these relationships remains unclear
Data are needed to better define the relationship between cystatin C and ventricular remodeling, which may clarify its relationship with heart failure and cardiovascular mortality and elucidate new mechanisms which may lead to development of novel therapies
Of 6,814 multi-ethnic study of atherosclerosis (MESA) participants, 1,786 did not have MRI measures of left ventricular (LV) structure and function, and 58 had no serum cystatin C measures, leaving 4,970 participants who were included at baseline for analysis
Summary
Reduced kidney function, approximated by elevated cystatin C, is associated with diastolic dysfunction, heart failure, and cardiovascular mortality; the precise mechanism(s) that account for these relationships remains unclear. Understanding the relationship between cystatin C and subclinical left ventricular (LV) remodeling, across ethnically diverse populations, may help explain the mechanisms underlying the association of kidney dysfunction with heart failure and cardiovascular mortality. Cystatin C levels were inversely associated with LVEDV and LVESV with a disproportionate decrease in LVEDV compared to LVM in a multi-ethnic population This morphometric pattern of concentric left ventricular remodeling, may in part explain the process by which kidney dysfunction leads to diastolic dysfunction, heart failure and cardiovascular mortality. Data are needed to better define the relationship between cystatin C and ventricular remodeling, which may clarify its relationship with heart failure and cardiovascular mortality and elucidate new mechanisms which may lead to development of novel therapies. We hypothesize that cystatin C is a marker for ventricular remodeling, independent of blood pressure, in a multi-ethnic population
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