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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 1  |  Page : 181-186

The correlation between serum adiponectin levels and severity of coronary artery disease


1 Department of Cardiology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Cardiology at Sohag Cardiac Center, Sohag, Egypt

Date of Submission13-Aug-2017
Date of Acceptance01-Oct-2017
Date of Web Publication17-Apr-2019

Correspondence Address:
Alshaimaa A Ahmed
Specialist at Cardiology Department, Sohag Cardiac Specialized Cente, Sohag
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_558_17

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  Abstract 


Objective
To evaluate the correlation between serum adiponectin levels and the severity of coronary artery disease (CAD) as assessed by coronary angiography.
Background
CAD is the leading cause of death worldwide. Adiponectin is a protein hormone that modulates a number of metabolic processes, including glucose regulation and acid oxidation. The severity of hypoadiponectinemia correlates with coronary lesions. Indeed, adiponectin levels are lower in patients having CAD.
Patients and methods
This cross-sectional study included 90 patients, comprising 36 patients with normal coronary arteries and 54 patients with CAD. Patients with CAD were subdivided into four groups according to the number of vessels affected. The severity of coronary lesions was assessed using the modified Gensini score. Serum adiponectin levels were measured in all patients.
Results
There was a significant negative linear correlation between serum adiponectin level and severity of CAD using modified Gensini score (r=−0.903; P < 0.001). There was significant decrease in serum adiponectin levels in patients with multivessel disease compared with patients with two-vessel disease and more significant decrease compared with patients with single-vessel disease. There was no significant difference between the both groups regarding mean age, smoking, hypertension, dyslipidemia, and family history.
Conclusion
Serum adiponectin levels decreased in patients with CAD compared with normal coronary arteries group. This decrease is more prominent with increasing levels of CAD severity, which may be helpful in risk stratification.

Keywords: adiponectin, coronary angiography, coronary artery disease, modified Gensini score


How to cite this article:
Farid W, Ibraheem R, Ahmed AA. The correlation between serum adiponectin levels and severity of coronary artery disease. Menoufia Med J 2019;32:181-6

How to cite this URL:
Farid W, Ibraheem R, Ahmed AA. The correlation between serum adiponectin levels and severity of coronary artery disease. Menoufia Med J [serial online] 2019 [cited 2019 Aug 23];32:181-6. Available from: http://www.mmj.eg.net/text.asp?2019/32/1/181/256125




  Introduction Top


Coronary artery disease (CAD) is the leading cause of death worldwide, and it is expected that the rate of CAD will accelerate in the next decade. The global burden of CAD carries with it a heavy financial cost [1]. Recently, adipose tissue has shed its label as a sedentary storage depot of excess energy and has emerged as a metabolically active participant in mediating vascular complications, serving as an active endocrine and paracrine organ secreting an increasing number of mediators, known as adipokines, which participate in diverse metabolic processes. Although most adipokines such as leptin, TNF, and a plasminogen activator inhibitor-1 appear to promote vascular disease, among these adipokines, adiponectin seems to possess antiatherogenic and anti-inflammatory effects and may be protective against cardiovascular disease development [1]. Adiponectin inhibits the transformation of human monocyte-derived macrophages into foam cells by inhibiting the class A macrophage scavenger receptor. Some findings suggest a role of adiponectin in atherosclerosis by inhibiting binding of LDL (Low-density lipoprotein) to biglycan, which is a vascular proteoglycan. This ultimately decreases lipid accumulation in the subendothelial space, the cause of atherosclerotic plaque formation [2]. The aim of the study was to evaluate the correlation between serum adiponectin levels and severity of CAD as assessed by coronary angiography using modified Gensini score [3],[4].


  Patients and Methods Top


It is a cross-sectional study. The study population included all patients referred to the catheterization unit in Menoufia University Hospital and Sohag Cardiac Center who underwent elective coronary angiography in the period from January 2016 to December 2016 and were suitable for our study. There were 90 patients who remained in the study after exclusion of 20 patients, as their samples were damaged. A detailed medical history was obtained from every patient, and risk factors of CAD were established. Patients were also evaluated by physical examination and 12-lead ECG (Cardimax FX2011; Fukuda Denshi Co., Hongo, Bunkyo-ku, Tokyo, Japan). Exclusion criteria were DM, infectious disease, thyroid dysfunction, liver dysfunction based on medical history or laboratory tests, neoplastic disease, and chronic renal failure (Cr>2.0 mg/dl), or on hemodialysis. The ethical implications regarding the study were approved by the local ethics committee, and informed consent was obtained from each patient. Demographic and clinical data evaluation and routine biochemistry analyses in the form of serum creatinine levels using kinetic method, lipid profile which were measured with colorimetric method (photometer 5010; Ultra Company, China), and serum adiponectin levels for all the patients were performed. Serum samples for adiponectin were centrifuged and stored at −20°C in the laboratory, and serum adiponectin levels were measured by ELISA method, using [Assay Max Human Adiponectin ELISA (Acrp30) kit; ASSAYPRO Company, LLC Laboratory Medicine Inc., 3400 Harry S Truman Blvd St. Charles, USA]. Selective coronary angiography (Siemens axiom artis PC, Germany) by standard Seldinger technique was performed for all patients. Evaluation of all coronary angiograms was made by two observers who were blinded to the clinical and laboratory data. The severity of coronary lesions was assessed using the modified Gensini score. Scoring was applied as follows: 5 scores for left-main coronary lesion; 2.5 scores for proximal left anterior descending artery and the left circumflex artery; 1.5 scores for the mid-left anterior descending artery lesion; 1 score for the first diagonal branch (D1), the obtuse marginal branches, and the right coronary artery; and 0.5 score for the second diagonal (D2) and the left circumflex artery posterior-lateral branch [3],[4].

Statistical analyses

Results were statistically analyzed by SPSS version 20 (SPSS Inc., Chicago, Illinois, USA). Student's t-test was used to indicate the significance between 2 means. χ2-Test was used for comparison regarding qualitative variables. Pearson's correlation was used to show strength and direction of association between two quantitative variables. Receiver operating characteristic curve is a graphical plot of the sensitivity, versus false positive rate (1 − specificity). P value was significant up to 0.05.


  Results Top


Our study included 90 patients divided into two groups: group A included 36 (21 males and 15 females) patients with normal coronary arteries, who remained in the study after exclusion of 19 patients, as their samples were damaged, and their mean age was 55.55 ± 11.62 years, and group B included 54 (41 male and 13 females) patients with CAD after exclusion of one patient, as his sample was damaged, and their mean age was 56.90 ± 11 years [Table 1]. Group B was then subdivided into group 1, with 17 patients (13 males and four females) with single-vessel disease; group 2, with 12 (seven males and five females) patients with two-vessel disease; group 3, with 19 (16 males and three females) patients with multivessel disease; and group 4, with six (five males and one female) patients with left-main disease. There was no statistically significant difference regarding age (P = 0.528) and sex (P = 0.077) in the studied groups. Smoking was significantly more prevalent in patients with CAD than those with normal coronary arteries (P = 0.037). Serum adiponectin level in patients with CAD was found to be statistically highly significantly lower than those with normal coronary arteries group (P < 0.001), and there was no statistically significant difference in patients with single-vessel disease and normal coronary arteries group (P = 0.092). However, serum adiponectin level was found to be significantly lower in the patients with two-vessel, multivessel disease, and LM disease compared with normal coronary arteries group (P < 0.001) [Table 1]. Ejection fraction was statistically significant higher in normal coronary arteries group and patients with multivessel disease compared with patients with single-vessel disease (P = 0.044). On the contrary, there was no statistically significant difference among other groups and subgroups compared with each other (P = 0.103). When analyzing subgroups of patients with CAD, we found that serum adiponectin level was statistically significant lower in patients with two-vessel disease (group 2), multivessel disease (group 3), and LM disease (group 4) compared with single-vessel disease (group 1). Moreover, it was statistically significant lower in patients with multivessel disease (group 3) compared with patients with two-vessel disease (group 2) (P < 0.05). However, there was no statistically significant difference in patients with LM disease (group 4) compared with patients with multivessel disease (group 3) and two-vessel disease (group 2) (P > 0.05). Regarding modified Gensini score, it was highly statistically significantly higher in patients with two-vessel disease (33.75 ± 17.73), multivessel disease (67.28 ± 41.61), and left-main disease (80.16 ± 47.25) compared with patients with single-vessel disease (8.02 ± 6.0), and in patients with multivessel disease and left-main disease compared with patients with two-vessel disease, whereas there was no statistically significant difference in patients with left-main disease compared with patients with multivessel disease, and this may be owing to a small number of patients in left-main disease group [Table 2]. Receiver operating characteristic curve showed that the cutoff value of serum adiponectin level for predicting CAD was less than 6.95 ng/ml, with sensitivity 85%, specificity 69%, accuracy 79%, PPV 81% and, NPV 76%, and cutoff value of serum adiponectin level for prediction of severity of CAD in two-vessel disease was less than 6.6 ng/ml, for multivessel disease was less than 5.9 ng/ml, and finally, for left-main disease was less than 5.8 ng/ml [Table 3] and [Figure 1]. There was a significant negative linear correlation between modified Gensini score and serum adiponectin levels in the studied patient group and subgroups [Table 4].
Table 1: Comparison between the studied groups regarding adiponectin, age, sex, and risk factors of coronary artery disease

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Table 2: Comparison of serum adiponectin levels, modified Gensini score, and ejection fraction in the studied groups and subgroups

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Table 3: Sensitivity, specificity, and accuracy of serum adiponectin levels in the studied patients and subgroups for detection of coronary artery disease and prediction of its severity

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Figure 1: ROC curves of the studied groups showing sensitivity, specificity, and accuracy of serum adiponectin levels for prediction of coronary artery disease (CAD) and detection of its severity.

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Table 4: Correlation between serum adiponectin levels and modified Gensini score in the studied groups and subgroups

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  Discussion Top


CAD is a major cause of death and disability in developed countries. Although CAD mortality rates worldwide have declined over the past four decades, CAD remains responsible for approximately one-third or more of all deaths in individuals older than 35 years [5],[6],[7]. Although most adipokines such as leptin, TNF, and a plasminogen activator inhibitor-1 appear to promote vascular disease, among these adipokines, adiponectin seems to possess antiatherogenic and anti-inflammatory effects and may be protective against cardiovascular disease development [1]. Therefore, understanding the clinical significance of adiponectin may be helpful in preventing the development of atherosclerotic vascular diseases [4]. This study showed that serum adiponectin levels were significantly lower in patients with angiographically diagnosed CAD compared with the normal coronary group. This agreed with the results reported by Mohamed et al. [8] who found serum adiponectin levels were significantly lower in patients group compared with the control group, and revealed that this finding might be attributed to the loss of protective functions of adiponectin on the vascular endothelium, which may allow vascular inflammatory events to occur more rapidly. Selcuk et al. [8] showed that patients with significant CAD had lower plasma adiponectin concentrations than those without CAD in a study performed for patients with metabolic syndrome undergoing coronary angiography. In addition, our study showed that serum adiponectin levels were not significantly different in single-vessel lesion compared with the normal coronary arteries group, whereas it was found to be significantly lower in patients with two-vessel, multivessel, and left-main disease when evaluated by usual method of scoring systems for severity of CAD. These results were confirmed by Gokosoy et al. [9] who found that serum adiponectin levels were not significantly different between patient subgroup with single-vessel disease and control group, whereas it was found to be significantly lower in the patient subgroups with two-vessel and multivessel disease compared with the control group. As a result, it may be suggested that low serum adiponectin levels may indicate multivessel (≥2 vessels) or left-main disease rather than single-vessel disease. This disagreed with another study reported by Mohamed et al. [10], in which, there was a significant difference in serum adiponectin levels in patients with single-vessel lesion compared with the control group. This may be attributed to small numbers of patients with single-vessel disease in our study compared with their study. In another study done by Cavuflolu et al. [11] in which coronary angiography was performed on male patients with stable angina pectoris, unstable angina pectoris, and non-ST-elevation myocardial infarction, it was found that low serum adiponectin levels were a predictor of acute myocardial infarction and cardiac mortality. It has been suggested that patients with CAD with complex lesions have lower serum adiponectin levels and that decreased adiponectin levels may indicate sensitivity of plaque [12]. When we analyzed CAD patient subgroups, we found that there was a significant negative correlation between serum adiponectin levels and modified Gensini scores, meaning that there was decreased serum adiponectin level with CAD progression, and it was highly statistically significantly higher in patients with two-vessel disease, multivessel disease, and left-main disease compared with patients with single-vessel disease, and in patient with multivessel disease and left-main disease compared with patients with two-vessel disease. Similar results were reported by Shams et al. [13] who found a significant linear negative correlation between serum adiponectin levels and severity of CAD based on usual method for reporting coronary angiogram. In this study, the mean Gensini score in the patient group was found to be 40.52 ± 41.02, and when we demonstrated the cutoff point of serum adiponectin level for detecting CAD, it was less than 6.95 ng/ml, with sensitivity of 85%, specificity of 69% and accuracy of 79%. Regarding the cutoff values of serum adiponectin level for prediction of severity of CAD in two-vessel disease, it was less than 6.6 ng/ml, for multivessel disease, it was less than 5.9 ng/ml, and finally for left-main disease, it was less than 5.8 ng/ml. In contrary to this study, Gokosy et al. [9] found that serum adiponectin level was 2.0 ± 2.0 μg/dl, and the mean Gensini score in the patients group was found to be 3.8 ± 1.7. Shams et al. [13] stated the mean serum adiponectin level was 11.4 ± 6.29 ng/ml and mean Gensini score was 33.2 ± 38.29. The strength of our study was that it approved the presence of a significant negative linear correlation between serum adiponectin levels and modified Gensini score as a predictor of severity of CAD not only in total patients but also in each subgroup of patients with CAD categorized by usual method of scoring system for reporting coronary angiogram individually. Limitation of this study was that only total form of adiponectin was measured, whereas high-molecular-weight adiponectin alone may be a clinically useful marker of CAD than total form.


  Conclusion Top


Serum adiponectin levels decreased in patients with CAD compared with normal coronary arteries group. This decrease is more prominent with increasing levels of CAD severity. Measurement of serum adiponectin may be used as a novel diagnostic tool for risk stratification of patients with CAD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Otsuka F, Sugiyama S, Kojima S, Maryoshi H, Funahashi T, Matsui K, et al. Plasma adiponectin levels are associated with coronary lesion complexity in men with coronary artery disease. J Am Coll Cardiol 2006; 48:1155–1162.  Back to cited text no. 12
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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