Adipokines and endothelial dysfunction in acute myocardial infarction and the risk of recurrent cardiovascular events.

AIMS

The aim of the study was to evaluate the prognostic role of adipokines (adiponectin, apelin, resistin, and visfatin) in patients with acute myocardial infarction (AMI) in relation to the extent of glucose metabolism impairment and intensity of systemic low-grade inflammation.

METHODS

This case-control study covered 131 patients with coronary artery disease: 104 consecutive patients with AMI (74% men, mean age of 62 ± 11 years) treated with primary percutaneous coronary intervention with stent implantation, and 27 patients with stable angina (70% men, mean age of 63 ± 11 years), who were initially assessed in terms of adipokine levels, C-reactive protein and various echocardiographic and vascular parameters. Major adverse cardiovascular events were recorded in the AMI group during 3-year follow-up.

RESULTS

Resistin and visfatin serum levels were significantly higher (P < 0.001), and adiponectin and apelin were lower (P < 0.001) in AMI patients as compared to patients with stable angina. In AMI patients, adipokine levels were not related to glucose metabolism disturbances, yet adiponectin (P = 0.03) and resistin (P = 0.001) concentrations were related to the number of affected coronary vessels. Serum adiponectin level correlated negatively (r = -0.608, P < 0.05), whereas resistin and visfatin correlated positively (r = 0.526, P < 0.05 and r = 0.352, P < 0.05, respectively) with C-reactive protein levels. All of the analyzed adipokines significantly accounted for the flow-mediated dilation variability (Radjusted 32%) in the AMI group. The Cox survival analysis indicated that resistin and visfatin were independent risk factors of recurrent AMI/unstable angina, with the diagnostic threshold above 12.2 ng/ml for resistin and above 11.8 ng/ml for visfatin concentrations.

CONCLUSION

An abnormal profile in serum adipokines observed in AMI is related to systemic inflammation and the degree of atherosclerosis independently of glucose metabolism disturbances and heralds major adverse cardiovascular event occurrence in long-term observation.