Department of Clinical Medicine, Thrombosis Research Center, UiT - The Arctic University of Norway, Tromsø, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Thromb Haemost. 2022 Apr;122(4):560-569. doi: 10.1055/s-0041-1732295. Epub 2021 Jul 11.
Circulating levels of leptin, an adipocyte-derived hormone, are frequently elevated in obesity. Leptin has been reported to upregulate prothrombotic hemostatic factors in vitro and could potentially mediate venous thromboembolism (VTE) risk in obesity. However, whether leptin is associated with VTE remains uncertain.
This article investigates the association between plasma leptin and risk of incident VTE, and the potential of leptin to mediate VTE risk in obesity.
A population-based nested case-control study with 416 VTE cases and 848 age- and sex-matched controls was derived from the Tromsø Study. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for VTE across leptin quartiles. Analyses were performed separately in men and women using sex-specific quartile cut-offs determined in controls.
In the age-adjusted model, the VTE risk increased across leptin quartiles, particularly in men. Compared with the lowest quartile, the ORs for VTE in the highest quartile were 1.70 (95% CI 1.04-2.79) in men and 1.36 (95% CI 0.85-2.17) in women. However, with additional adjustment for body mass index (BMI), risk estimates were markedly attenuated in men (OR 1.03, 95% CI 0.55-1.93) and women (OR 0.82, 95% CI 0.45-1.48). The ORs for VTE were increased in obese men and women (BMI ≥ 30 kg/m) and were only marginally affected after adjustment for leptin.
Our results indicate that the apparent association between plasma leptin levels and VTE risk is confounded by BMI and that leptin is not a relevant mediator for VTE risk in obesity.
循环中瘦素水平，一种脂肪细胞衍生的激素，在肥胖症中经常升高。有报道称，瘦素可体外上调促血栓形成的止血因子，并可能介导肥胖症中的静脉血栓栓塞（VTE）风险。然而，瘦素是否与 VTE 相关仍不确定。
本研究旨在探讨血浆瘦素与 VTE 发病风险的关系，以及瘦素在肥胖症中对 VTE 风险的潜在介导作用。
本研究采用基于人群的巢式病例对照研究，416 例 VTE 患者和 848 例年龄和性别匹配的对照者来自特罗姆瑟研究。使用逻辑回归计算 VTE 在瘦素四分位区间的比值比（OR）及其 95%置信区间（CI）。使用在对照组中确定的性别特异性四分位位值，分别在男性和女性中进行分析。
在年龄调整模型中，VTE 风险随瘦素四分位区间的升高而增加，尤其是在男性中。与最低四分位区间相比，最高四分位区间男性的 VTE OR 为 1.70（95%CI 1.04-2.79），女性为 1.36（95%CI 0.85-2.17）。然而，在进一步调整体重指数（BMI）后，男性（OR 1.03，95%CI 0.55-1.93）和女性（OR 0.82，95%CI 0.45-1.48）的风险估计值明显减弱。在肥胖的男性和女性（BMI≥30kg/m）中，VTE 的 OR 增加，并且在调整瘦素后仅略有影响。
我们的结果表明，血浆瘦素水平与 VTE 风险之间的明显关联受 BMI 混杂，并且瘦素不是肥胖症中 VTE 风险的相关介导物。
