Romero-Corral Abel, Sierra-Johnson Justo, Lopez-Jimenez Francisco, Thomas Randal J, Singh Prachi, Hoffmann Michal, Okcay Aynur, Korinek Josef, Wolk Robert, Somers Virend K
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Nat Clin Pract Cardiovasc Med. 2008 Jul;5(7):418-25. doi: 10.1038/ncpcardio1218. Epub 2008 Apr 22.
Leptin could be a key regulator of C-reactive protein (CRP) levels, which serve as a marker of systemic inflammation. Both leptin and CRP are predictors of cardiovascular disease (CVD). However, the interactions between leptin and CRP, and their association with CVD, remain unclear. We therefore studied them in a large, multiethnic population.
We analyzed leptin and CRP levels, anthropometric variables and cardiovascular risk factor data from 6,251 participants from the Third National Health and Nutrition Examination Survey (NHANES III). Logistic regression was used to estimate the association between leptin, CRP and CVD (defined as history of myocardial infarction or stroke). Receiver operating characteristic curves were created to study the additional value of leptin and CRP for the association with CVD.
The mean age was 44.4 +/- 0.21 years (52.5% women). After adjustment for age, race, dyslipidemia, hypertension, diabetes, smoking, obesity and CRP, high levels of leptin were significantly associated with CVD in men (odds ratio 2.47, 95% CI 1.19-5.19) and in women (odds ratio 3.30, 95% CI 1.47-7.99). After adjustment for leptin, CRP was not associated with CVD. There was a significant correlation between levels of leptin and CRP (Spearman correlation rho = 0.22 in men and rho = 0.32 in women, both P < 0.0001). The area under the curve, representing the association between cardiovascular risk factors and CVD, increased after the addition of high levels of both leptin and CRP together.
High leptin levels are independently associated with CVD even after adjustment for CRP; elevated CRP levels are not associated with CVD after adjustment for leptin. However, increased concentrations of both leptin and CRP confer the highest risk for CVD.
瘦素可能是C反应蛋白（CRP）水平的关键调节因子，CRP是全身炎症的标志物。瘦素和CRP都是心血管疾病（CVD）的预测指标。然而，瘦素与CRP之间的相互作用及其与CVD的关联仍不清楚。因此，我们在一个大型多民族人群中对它们进行了研究。
我们分析了来自第三次全国健康与营养检查调查（NHANES III）的6251名参与者的瘦素和CRP水平、人体测量变量以及心血管危险因素数据。采用逻辑回归来估计瘦素、CRP与CVD（定义为心肌梗死或中风病史）之间的关联。绘制受试者工作特征曲线以研究瘦素和CRP与CVD关联的附加价值。
平均年龄为44.4±0.21岁（52.5%为女性）。在调整年龄、种族、血脂异常、高血压、糖尿病、吸烟、肥胖和CRP后，高水平的瘦素与男性CVD显著相关（比值比2.47，95%可信区间1.19 - 5.19），与女性CVD也显著相关（比值比3.30，95%可信区间1.47 - 7.99）。在调整瘦素后，CRP与CVD无关。瘦素水平与CRP水平之间存在显著相关性（男性Spearman相关系数ρ = 0.22，女性ρ = 0.32，P均<0.0001）。同时加入高水平的瘦素和CRP后，代表心血管危险因素与CVD之间关联的曲线下面积增加。
即使在调整CRP后，高瘦素水平仍与CVD独立相关；在调整瘦素后，CRP水平升高与CVD无关。然而，瘦素和CRP浓度的增加赋予CVD最高风险。
