Leptin predicts independently a first-ever STEMI in men, data from a large prospective nested case-referent study

• Purpose: The adipocyte derived hormone leptin could be a mediator between obesity and increased risk for cardiovascular disease (CVD), asleptin has been linked to the atherosclerotic process. We hypothesised that leptin predicted independently a myocardial infarction (MI).Methods: A prospective nested case-referent study was set up within the framework of the Northern Sweden MONitoring of Trends and Determinants in CArdiovascular Diseases (MONICA) project, the Västerbotten Intervention Program (VIP), and the Mammary Screening Program (MSP). Subjects (n=564, 40% women) with a first-ever acute MI that had participated in one of these surveys prior to the MI were selected. Age, sex, survey and location matched referents (n=1082, 40% women) were selected within the surveys. Leptin was measured instored plasma. Conditional logistic regression was used to determine the risk for MI. Type of MI (STEMI and NSTEMI) was classified according to Minnesota codes.Results: The time period between survey and event was 3.9 years (interquartile range 3.6), and 51% of the cases had STEMI, 29% had NSTEMI, and 21% were unclassified. Male and female cases had higher levels of leptin (5.0 vs. 4.1 ng/mL, p<0.001 and 15.4 vs. 14.0 ng/mL, p=0.03), compared to referents. High leptin levels predicted MIindependently in men (OR 2.17 [1.32-3.54], ptrend<0.001), but not inwomen (OR 1.10 [0.55-2.18], ptrend=0.05). The risk related to leptin inmen was seen for STEMI in particular.Conclusions: High leptin predicts first–ever fatal and non–fatal MI, notably with a gender and MI-type difference. Leptin may affect theatherosclerotic process differentially in men and women and may promote plaque rupture and thrombus formation in larger coronary vessels.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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