Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.
Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Cardiovasc Diabetol. 2019 Sep 30;18(1):126. doi: 10.1186/s12933-019-0931-0.
BACKGROUND/OBJECTIVES: Pericoronary adipose tissue inflammation might lead to the development and destabilization of coronary plaques in prediabetic patients. Here, we evaluated inflammation and leptin to adiponectin ratio in pericoronary fat from patients subjected to coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI). Furthermore, we compared the 12-month prognosis of prediabetic patients compared to normoglycemic patients (NG). Finally, the effect of metformin therapy on pericoronary fat inflammation and 12-months prognosis in AMI-prediabetic patients was also evaluated.
An observational prospective study was conducted on patients with first AMI referred for CABG. Participants were divided in prediabetic and NG-patients. Prediabetic patients were divided in two groups; never-metformin-users and current-metformin-users receiving metformin therapy for almost 6 months before CABG. During the by-pass procedure on epicardial coronary portion, the pericoronary fat was removed from the surrounding stenosis area. The primary endpoints were the assessments of Major-Adverse-Cardiac-Events (MACE) at 12-month follow-up. Moreover, inflammatory tone was evaluated by measuring pericoronary fat levels of tumor necrosis factor-α (TNF-α), sirtuin 6 (SIRT6), and leptin to adiponectin ratio. Finally, inflammatory tone was correlated to the MACE during the 12-months follow-up.
The MACE was 9.1% in all prediabetic patients and 3% in NG-patients. In prediabetic patients, current-metformin-users presented a significantly lower rate of MACE compared to prediabetic patients never-metformin-users. In addition, prediabetic patients showed higher inflammatory tone and leptin to adiponectin ratio in pericoronary fat compared to NG-patients (P < 0.001). Prediabetic never-metformin-users showed higher inflammatory tone and leptin to adiponectin ratio in pericoronary fat compared to current-metformin-users (P < 0.001). Remarkably, inflammatory tone and leptin to adiponectin ratio was significantly related to the MACE during the 12-months follow-up.
Prediabetes increase inflammatory burden in pericoronary adipose tissue. Metformin by reducing inflammatory tone and leptin to adiponectin ratio in pericoronary fat may improve prognosis in prediabetic patients with AMI. Trial registration Clinical Trial NCT03360981, Retrospectively Registered 7 January 2018.
背景/目的： 冠状周围脂肪组织的炎症可能导致糖尿病前期患者冠状动脉斑块的发展和不稳定。在这里，我们评估了接受冠状动脉旁路移植术（CABG）治疗急性心肌梗死（AMI）的患者冠状周围脂肪中的炎症和瘦素与脂联素的比值。此外，我们比较了糖尿病前期患者与正常血糖患者（NG）的 12 个月预后。最后，还评估了二甲双胍治疗对 AMI 糖尿病前期患者冠状周围脂肪炎症和 12 个月预后的影响。
对首次因 AMI 而接受 CABG 的患者进行了一项观察性前瞻性研究。参与者被分为糖尿病前期和 NG 患者。糖尿病前期患者分为两组：从未使用二甲双胍的患者和在 CABG 前近 6 个月开始使用二甲双胍的患者。在心脏外膜冠状段旁路手术过程中，从周围狭窄区域切除冠状周围脂肪。主要终点是在 12 个月随访时评估主要不良心脏事件（MACE）。此外，通过测量肿瘤坏死因子-α（TNF-α）、SIRT6 和瘦素与脂联素的比值来评估冠状周围脂肪的炎症程度。最后，炎症程度与 12 个月随访期间的 MACE 相关。
所有糖尿病前期患者的 MACE 为 9.1%，NG 患者为 3%。在糖尿病前期患者中，目前使用二甲双胍的患者的 MACE 发生率明显低于从未使用二甲双胍的患者。此外，与 NG 患者相比，糖尿病前期患者的冠状周围脂肪中炎症程度和瘦素与脂联素的比值更高（P < 0.001）。与目前使用二甲双胍的患者相比，糖尿病前期患者从不使用二甲双胍的患者的冠状周围脂肪中的炎症程度和瘦素与脂联素的比值更高（P < 0.001）。值得注意的是，炎症程度和瘦素与脂联素的比值与 12 个月随访期间的 MACE 显著相关。
糖尿病前期增加了冠状周围脂肪组织的炎症负担。二甲双胍通过降低冠状周围脂肪中的炎症程度和瘦素与脂联素的比值，可能改善 AMI 糖尿病前期患者的预后。试验注册 临床试验 NCT03360981，2018 年 1 月 7 日回顾性注册。
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