Circulating adipokines and insulin resistance in subjects with combined cardiac and metabolic syndrome X.

Kae-Woei Liang,Ying-Chieh Liao,Wen-Lieng Lee,Jun-Sing Wang,Kuo-Yang Wang,Wayne H.-H Sheu,Wen-Jane Lee,I.-Te Lee

doi:10.1186/s13098-015-0078-4

Abstract

BackgroundCardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study showed that CSX subjects had decreased serum adiponectin but higher leptin and insulin resistance (IR). However, few studies have investigated circulating adipokines and IR in subjects with combined metabolic syndrome X (MetX) and CSX.MethodsFifty-nine subjects with CSX were retrospectively enrolled from our cardiac catheterization patient databank. Fifty-four subjects with valvular heart disease or arrhythmia and with normal coronary angiograms were recruited as the non-CSX comparison group. The study subjects were reclassified according to the presence or absence of MetX. Circulating adipokines and degree of IR were measured.ResultsSubjects with combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin level (median 8.7 vs. 3.3 ng/mL, p < 0.001), but a lower circulating adiponectin level (median 2.8 vs. 12.3 μg/mL, p < 0.001) than those without MetX and CSX. In pairwise comparisons, combined MetX and CSX subjects had a similar circulating adipokines and IR index as those who had only either one syndrome X. In a multivariate regression analysis, serum triglycerides (odds ratio 1.011, p = 0.024) and hypertension (odds ratio 14.453, p = 0.003) were independently associated with diagnosis of combined MetX and CSX.ConclusionsCombined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin but a lower circulating adiponectin level than those without MetX and CSX. Combined syndrome X did not confer more changes on adipokines or IR index comparing with those with only one syndrome X.

Highlights

Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries
Binary logistic regression analysis of variables associated with the diagnosis of “CSX without Metabolic syndrome X (MetX)” Using “CSX without MetX” as the dependent variable, we found that higher serum triglycerides and higher circulating adiponectin were negatively associated with the diagnosis of “CSX without MetX” (Table 4)
Binary logistic regression analysis of variables associated with the diagnosis of “MetX without CSX” Using “MetX without CSX” as the dependent variable, we found that body mass index (BMI) was positively correlated, while higher HDL-C and male gender were negatively associated with the diagnosis of “MetX without CSX” (Table 5)

Summary

Introduction

Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study showed that CSX subjects had decreased serum adiponectin but higher leptin and insulin resistance (IR). Subjects with cardiac syndrome X (CSX) have angina like symptoms with evidence of ischemia in stress electrocardiogram or isotope perfusion scan but with patent epicardial coronary arteries on coronary angiogram [9,10,11]. Hyperinsulinemia during oral glucose tolerance test was more prominent in the CSX group than in controls, which implies that IR might contribute to the micro-vascular angina [14]. Using hyper-insulinemia and the euglycemia clamp test, other investigators found that subjects with CSX or MetX had higher degree of IR as compared to controls [16]

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