First Department of Internal Medicine, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece.
Eur J Clin Invest. 2012 Dec;42(12):1278-86. doi: 10.1111/j.1365-2362.2012.02728.x. Epub 2012 Oct 3.
In patients with carotid stenosis, we prospectively investigated the association of novel adipokines, apelin and visfatin, with gray-scale median (GSM) score, a valid index of carotid plaque vulnerability. We also assessed the impact of atorvastatin therapy on the above biochemical and imaging markers.
Seventy-four overweight [body-mass index (BMI) > 25 kg/m(2) , fat-mass > 30%], statin-free patients, with carotid stenosis, but without indications for intervention were enrolled. Thirty-eight age-, sex- and BMI-matched healthy subjects served as healthy controls (HC). All patients received gradual titrated (10-80 mg) atorvastatin therapy to target LDL-C < 100 mg/dL. GSM score, blood pressure (BP), fat-mass, lipid profile, and serum high-sensitivity C-reactive protein (hsCRP), apelin and visfatin levels were obtained at baseline and after 24 months.
At baseline, patients with carotid atherosclerosis had worse lipid profile, lower apelin and higher systolic BP, hsCRP, visfatin levels compared with HC (P < 0·05). Notably, decreased apelin (P < 0·001) and GSM score (P = 0·010), while increased visfatin (P = 0·019) and hsCRP (P = 0·039) levels were found in symptomatic rather than asymptomatic patients. At baseline, GSM score correlated with fat-mass, BMI, LDL-C, visfatin and apelin (P < 0·05). Apelin, visfatin and fat-mass remained independent determinants of baseline GSM score (R(2) = 0·391, P = 0·007). In parallel, we found that apelin increment and LDL-C reduction were independently associated with the atorvastatin-induced GSM increase (R(2) = 0·411, P = 0·011).
Increased fat-mass, low apelin and high visfatin serum levels seem to correlate with carotid plaque vulnerability in patients with carotid stenosis. The atorvastatin-induced modification of apelin and LDL-C may beneficially affect carotid plaque stability.
在颈动脉狭窄患者中，我们前瞻性地研究了新型脂肪因子，apelin 和 visfatin，与颈动脉斑块易损性的有效指标——灰阶中位数（GSM）评分之间的关系。我们还评估了阿托伐他汀治疗对上述生化和影像学标志物的影响。
74 名超重（BMI>25kg/m²，体脂>30%）、无他汀类药物治疗且颈动脉狭窄但无介入指征的患者被纳入研究。38 名年龄、性别和 BMI 匹配的健康受试者作为健康对照组（HC）。所有患者均接受逐渐滴定剂量（10-80mg）的阿托伐他汀治疗，目标 LDL-C<100mg/dL。在基线和 24 个月时，获取 GSM 评分、血压（BP）、体脂、血脂谱和血清高敏 C 反应蛋白（hsCRP）、apelin 和 visfatin 水平。
在基线时，与 HC 相比，患有颈动脉粥样硬化的患者血脂谱更差，apelin 水平更低，收缩压、hsCRP、visfatin 水平更高（P<0.05）。值得注意的是，在有症状而非无症状患者中，apelin（P<0.001）和 GSM 评分（P=0.010）降低，而 visfatin（P=0.019）和 hsCRP（P=0.039）水平升高。在基线时，GSM 评分与体脂、BMI、LDL-C、visfatin 和 apelin 相关（P<0.05）。apelin、visfatin 和体脂是基线 GSM 评分的独立决定因素（R²=0.391，P=0.007）。同时，我们发现 apelin 增加和 LDL-C 降低与阿托伐他汀诱导的 GSM 增加独立相关（R²=0.411，P=0.011）。
在颈动脉狭窄患者中，体脂增加、apelin 水平降低和 visfatin 血清水平升高似乎与颈动脉斑块易损性相关。阿托伐他汀治疗引起的 apelin 和 LDL-C 变化可能有利于颈动脉斑块的稳定性。
