Sattar Naveed, Wannamethee Goya, Sarwar Nadeem, Chernova Julia, Lawlor Debbie A, Kelly Anne, Wallace A Michael, Danesh John, Whincup Peter H
BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine, University of Glasgow, Glasgow, Scotland, UK.
J Am Coll Cardiol. 2009 Jan 13;53(2):167-75. doi: 10.1016/j.jacc.2008.09.035.
This study sought to better determine the link between leptin and coronary heart disease (CHD).
Circulating leptin is considered a risk factor for CHD but larger studies are needed.
Leptin levels were measured in 550 men with fatal CHD or nonfatal myocardial infarction and in 1,184 controls nested within a prospective study of 5,661 British men and set in context with a meta-analysis.
Baseline leptin correlated with body mass index (BMI), blood pressure, total cholesterol, triglyceride, and inflammatory markers; correlations persisted after BMI adjustment. The within-person consistency of leptin values over 4 years (correlation coefficient: 0.79; 95% confidence interval [CI]: 0.73 to 0.83) was higher than those of some established cardiovascular risk factors. In a comparison of individuals in the top third with those in the bottom third of baseline leptin, the age- and town-adjusted odds ratio for CHD was 1.25 (95% CI: 0.96 to 1.62), decreasing to 0.98 (95% CI: 0.72 to 1.34) after adjustment for BMI. A systematic review identified 7 prospective reports with heterogeneous findings (I(2) = 60%, 13% to 82%). The combined adjusted risk ratio across all studies was 1.44 (95% CI: 0.95 to 2.16) in a comparison of extreme thirds of leptin levels. The inconsistency between studies was partially explained by sample size, with combined estimates from studies involving >100 CHD cases (1.28, 95% CI: 0.80 to 2.04) being somewhat weaker than those from smaller studies (1.81, 95% CI: 0.76 to 4.31).
Previous studies appear to have overestimated associations of leptin and CHD risk. Our results suggest a moderate association that is largely dependent on BMI.
本研究旨在更好地确定瘦素与冠心病（CHD）之间的联系。
循环瘦素被认为是冠心病的一个危险因素，但需要更大规模的研究。
在一项对5661名英国男性进行的前瞻性研究中，对550名患有致命性冠心病或非致命性心肌梗死的男性以及1184名对照者测量了瘦素水平，并结合一项荟萃分析进行背景分析。
基线瘦素与体重指数（BMI）、血压、总胆固醇、甘油三酯和炎症标志物相关；在调整BMI后，相关性依然存在。瘦素值在4年中的个体内一致性（相关系数：0.79；95%置信区间[CI]：0.73至0.83）高于一些已确定的心血管危险因素。在比较基线瘦素水平处于前三分之一的个体与后三分之一的个体时，经年龄和城镇调整后的冠心病优势比为1.25（95%CI：0.96至1.62），在调整BMI后降至0.98（95%CI：0.72至1.34）。一项系统评价确定了7篇有不同结果的前瞻性报告（I(2)=60%，13%至82%）。在比较瘦素水平处于极端三分之一的个体时，所有研究的综合调整风险比为1.44（95%CI：0.95至2.16）。研究之间的不一致部分由样本量解释，涉及>100例冠心病病例的研究的综合估计值（1.28，95%CI：0.80至2.04）比小型研究的估计值（1.81，95%CI：0.76至4.31）略弱。
先前的研究似乎高估了瘦素与冠心病风险之间的关联。我们的结果表明存在一种适度的关联，且很大程度上依赖于BMI。
