Abstract
ObjectiveCoronary artery disease (CAD) is associated with abdominal obesity and metabolic syndrome. Adipocytes secrete adipokines, including the newly discovered adipocyte fatty acid binding protein (A-FABP) and chemerin. Adipokines contribute to the pathogenesis of CAD. In patients with CAD, the presence of significant ischemia predicts adverse outcomes. It is unknown whether adipokines can be better predictors of the presence of significant myocardial ischemia than conventional risk factors. This study aimed to compare adipokines with clinical risk factors and abdominal obesity as predictive factors for significant myocardial ischemia.MethodsOne hundred and ninety-six adults with suspected, but unproven, CAD were consecutively enrolled. The main measures were clinical and biochemical parameters and stress myocardial perfusion imaging with gated myocardial perfusion single-photon emission computed tomography (SPECT), with computed tomography (CT) attenuation correction. The abdominal visceral fat area was examined using a hybrid SPECT/CT scanner. Serum levels of high-sensitivity C-reactive protein (hs-CRP) and adipokines (adiponectin, A-FABP, and chemerin) were evaluated.ResultsA-FABP levels correlated significantly with adiponectin, hs-CRP, body mass index, waist circumference, and visceral fat area. A-FABP was significantly associated with metabolic syndrome (OR 3.2, 95% CI 1.6–6.4, p = 0.001), significant myocardial ischemia (OR 1.9, 95% CI 1.0–3.4, p = 0.05), and stress lung-to-heart ratio (β = 0.03, p = 0.03) on SPECT. Chemerin was significantly associated with serum triglyceride levels but not with metabolic syndrome, significant ischemia, or stress lung-to-heart ratio on SPECT. A-FABP was better at detecting significant inducible ischemia than other biomarkers, although this was a modest improvement (area under ROC curve 0.579, 95% CI 0.46–0.69).ConclusionsSerum A-FABP concentrations correlate significantly with visceral fat area, metabolic syndrome, and predicted significant myocardial ischemia on SPECT. This may help to more accurately assess CAD risk, especially in patients with metabolic syndrome.
Highlights
Obesity, a state of excessive adipose tissue, has long been known to be a risk factor for the development of cardiovascular disease [1,2]
adipocyte fatty acid binding protein (A-FABP) was significantly associated with metabolic syndrome, significant myocardial ischemia, and stress lung-to-heart ratio (b = 0.03, p = 0.03) on single-photon emission computed tomography (SPECT)
Chemerin was significantly associated with serum triglyceride levels but not with metabolic syndrome, significant ischemia, or stress lung-to-heart ratio on SPECT
Summary
A state of excessive adipose tissue, has long been known to be a risk factor for the development of cardiovascular disease [1,2]. Adipose tissue has been traditionally considered a fat-storage organ, but is known to have an active role in systemic metabolism through the active secretion of adipokines. These adipokines can target distant organs and have major effects on body weight, energy storage, insulin sensitivity, glucose regulation, and the inflammatory response. Visceral fat is associated with an increased risk of atherosclerosis compared to subcutaneous fat [6,7] According to these findings, the dysregulation of adipokines has been proposed as a potential link between obesity and cardiovascular disease [8]. It is important to clarify the roles of different adipokines in the mechanism of metabolic disorders
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